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01-060 Republic Electric~~, n~° CONTRACT FOR PUBLIC WORKS This CONTRACT made on VI Jt ~ ~ p~~~ I by the CITY OF CUPERTINO, a municipal corporation of the tate of California, hereinafter called CITY, and REPUBLIC ELECTRIC, hereinafter called CONTRACTOR. IT IS HEREBY AGREED by CITY and CONTRACTOR as follows: 1. THE CONTRACT DOCUMENTS. The complete contract consists of the following contract documents: a. Notice to Contractors, Proposal, Time of Completion, Estimated Quantities, Noncollusion Affidavit, Bidder Qualification Form, Subcontractors Form and Signature Form. b. Standard Specifications, General Provisions acid Special Provisions. c. Plans and Specifications for SAFE ROUTES TO SCHOOL PROGRAM, PROJECT NO. 9541 d. Faithful Performance Bond and Materials Bond. e. Insurance Agreement, Certificate of Insurance, Endorsement of Primary Insurance, Additional Insured Endorsement, Endorsement of Aggregate Limits of Insurance per Project, Waiver of Subrogation Endorsement Worker's Compensation Insurance and Notice of Policy Cancellation Endorsement. £ This Contract for Public Works. All of the above documents are intended to cooperate so that any work called for in one and not mentioned in the other, or vice versa, is to be executed the same as if mentioned in all of said documents. The documents comprising the complete contract are sometimes hereinafter referred to as the Contract Documents. In case of conflict between the Plans and the Specifications on the one hand, and this Contract on the other, the Plan:; and Specifications shall prevail. 2. THE WORK. CONTRACTOR agrees to furnish all of the tools, equipment, apparatus, facilities, labor, transportation and materials necessary to perform and complete in a good and working order, the CONSTRUCTION, as called for, and in the manner designated in, and in strict conformity with, the Plans and Specifications prepared by the Engineer and adopted by CITY, which Plans and Specifications are entitled, respectively, SAFE ROUTES TO SCHOOL PROGRAM, PROJECT NO. 9541 and which. Plans and Specifications are identified by the signatures of the parties to this Contract. It is understood and agreed that said tools, equipment, apparatus, facilities, labor, transportation and materials shall be furnished, and that said work shall be performed and completed as required in said Plans and Specifications under the sole direction of CONTRACTOR, but subject to the inspection and approval of CITY, or its representative. CITY hereby designates as its representative for the purpose of this Contract the Engineer, Mr. Ralph A. Qualls, Jr. ORIGINAL 3. CONTRACT PRICE. CITY agrees to pay, and CONTRACTOR agrees to accept, in full payment for the work above agreed to be done, the sum of $ 299,500.00 (TWO HUNDRED NINTY NINE THOUSAND, FIVE HUNDR1sD DOLLARS), subject to additions and/or deductions as provided in the Contract Document:;, per Exhibit A attached hereto. 4. DISPUTES PERTAINING TO PAYMENT FOR WORK. Should any dispute arise respecting the true value of the work done, or any work omitted, or any extra work which CONTRACTOR may be required to do, or respecting the size of any payment to CONTRACTOR during the performance of this ('ontract, said dispute shall be determined either by reference to the Unit Prices bid, if applicable, or in accordance with agreement of prices, if applicable, or in accordance with the agreement ~~f the parties, or in accordance with Section 6, paragraph "f' of the General Provisions. 5. PERMITS, COMPLIANCE WITH LAW. CONTRACTOR shall obtain and bear all expense for all necessary permits, licenses and ea;~ements for the construction of the project, give all necessary notices, pay all fees required by la.w, and comply with the laws, ordinances and regulations relating to the work and to the preservation of the public health and safety. 6. INSPECTION BY THE CITY. CONTRACTOR shall at all times maintain proper facilities and provide safe access for inspection b}~ CITY to all parts of the work, and to the shops wherein the work is in preparation. Where the Specifications require work to be specially tested or approved, it shall not be tested or covered up without timely notice to CITY of its readiness for inspection and without the approval thereof ~r consent thereto by CITY. Should any such work be covered up without such notice, approv;~l, or consent, it must, if required by CITY, be uncovered for examination at CONTRACTOR'S expense. 7. EXTRA OR ADDITIONAL WORK AND I~HANGES. Should CITY at any time during the progress of the work require any alterations, deviations, additions or omissions from the Plans and Specifications or the Contract Doc~xments, CITY shall have the right to do so, and the same shall in no way affect or make void the- Contract, but the cost or value thereof will be added to, or deducted from, the amount of the Contract price, as the case may be, by a fair and reasonable valuation, which shall be determined either by reference to the Unit Prices bid, if applicable, the Standard Specifications, or in accordance with the agreement of the parties. No extra work shall be performed or change be made except by a written order from CITY, duly authorized by resolution of the City Council, anti by all agencies whose approval is required by law, stating that the extra work or change is authorized, and no claim for an addition to the Contract sum shall be valid unless so ordered. 8. CHANGES TO MEET ENVIRONMENTAL REQUIREMENTS. CITY shall have the right to make changes in this Contract during thy: course of construction to bring the completed improvements into compliance with environmental requirements or standards established by State and Federal statutes and regulations after ~:he Contract has been awarded or entered into. CONTRACTOR shall be paid for such changes either by reference to the Unit Prices bid, if applicable, or in accordance with the agreement of the parties. 9. TERMINATION, AMENDMENT OR MODIFICATION. This Contract may be terminated, amended or modified, with the mutual consent of the parties. The compensation 2 payable, if any, for such termination, amendment or modification, shall be determined either by reference to the Unit Price bid, if applicable, the Standard Specifications, or in accordance with the agreement of the parties. 10. TIME FOR COMPLETION. All work under this Contract shall be completed in accordance with the Time for Completion sectio~i in the Proposal and the Specifications of this project. If CONTRACTOR shall be delayed in the work by the acts or neglect of CITY, or its employees, or those under it by contract or otherwise, or by changes ordered in the work, or by strikes, lockouts by others, fire, unusual delay iii transportation, unavoidable casualties or any causes beyond CONTRACTOR'S control, or by delay authorized by CITY, or by any cause which CITY shall determine justifies the delay, then the time of completion shall be extended accordingly. This paragraph does not exclude th~~ recovery of damages for delay by either party under other provisions in the Contract Documents. 11. INSPECTION AND TESTING OF MATERIALS. CONTRACTOR shall notify CITY a sufficient time in advance of the manufacture, I~roduction or testing of materials to be supplied under this Contract, in order that CITY may arrange for mill, factory or laboratory inspection and testing of same. 12. TERMINATION FOR BREACH OR INSOLVENCY. If CONTRACTOR should be adjudged a bankrupt, or should make a general assignment for the benefit of creditors, or if a receiver should be appointed on account of insolvency, or if CONTRACTOR or any subcontractor should violate any of the provisions of the Contract, CITY may serve written notice upon CONTRACTOR and CONTRACTOR'S surety of its intention to terminate the Contract. Such notice shall contain the reasons i or CITY'S intention to terminate the Contract, and unless within ten (10) days after serving of such notice, such violation shall cease and satisfactory arrangements for corrections thereof lie made, the Contract shall, upon the expiration of said ten (10) days, cease and terminate. In the event of any such termination, CITY shall immediately serve notice thereof upon CONTR~,CTOR'S surety and CONTRACTOR, and the surety shall have the right to take over and perform the Contract; provided, however, that, if the surety within fifteen (15) days after the serving upon it of notice of termination does not give CITY written notice of its intention to take over and perform the Contract, or does not commence performance thereof within thirty (30) days from the date of the serving of such notice, CITY may take over the work and prose~~ute the same to completion by contract, or by any other method it may deem advisable, for the :account and~at the expense of CONTRACTOR, and CONTRACTOR AND CONTRACTOR'S surety shall be liable to CITY for any excess cost occasioned by CITY thereby, and in such event CITY may, without liability for so doing, take possession of, and utilize in completing the work, such materials, appliances, plant and other property belonging to CONTRACTOR as maybe on the site of the work and necessary therefor. 13. THE CITY'S RIGHT TO WITHHOLD CERTAIN AMOUNTS AND MAKE APPLICATION THEREOF. In addition to amounts which CITY may retain under other provisions of the Specifications until final completion and acceptance of all work covered by the Contract, CITY may withhold from payment to CONTRACTOR such an amount or amounts as in its judgment may be necessary to pay just claims against CONTRACTOR or subcontractors for labor and services rendered and materials furnished in and about the work. 3 City may apply such withheld amount or amounts to the payment of such claims in its discretion. In doing so, CITY shall be deemed the agent of CONTRACTOR, and any payment so made by CITY shall be considered as a payment made under the Contract by CITY to CONTRACTOR, and CITY shall not be liable to CONTRACTOR for any payment made in good faith. Such payment may be made without prior judicial determination of the claim or claims. With respect to any retention of payment by CITY to ensure performance of the Contract, CONTRACTOR will be entitled to substitute securities as provided in Section 4590 of the California Government Code as more fully described in CITY'S Notice to Contractors. 14. NOTICE AND SERVICE THEREOF. Any notice from one party to the other under this Contract shall be in writing, and shall be dated and signed either by the party giving such notice, or by a duly authorized representative of such party. Any such notice shall not be effective for any purpose whatsoever unless servc;d in the following manner: (a) if the notice is given to CITY, either by personal delivery there-of to the Engineer of CITY, or by depositing same in the United States mails, enclosed in a sealed envelope, addressed to CITY OF CUPERTINO; 10300 TORRE AVENUE; CU]PERTINO, CA 95014; postage prepaid and certified; (b) if the notice is given to CONTRACTOR, either by personal delivery thereof to CONTRACTOR, or to CONTRACTOR'S dul}~ authorized representative at the site of the project, or by depositing same in the United States mails enclosed in a sealed envelope, addressed to, 7120 REDWOOD BOULEVARD, ~VOVATA CA 94545-4114, postage prepaid and certified; and (c) if notice is given to CONTRACTOR'S surety or any other person, either by personal delivery thereof to CONTRACTOR'S surely or other person, or by depositing same in the United States mails, enclosed in a se;~led envelope, addressed to CONTRACTOR' S surety or person, as the case may be, at the address of CONTRACTOR' S surety or the address of the person last communicated by such person to the party giving the notice, postage prepaid and certified. 15. ASSIGNMENT OF CONTRACT. Neither the Contract, nor any part thereof, nor moneys due or to become due thereunder, shall be: assigned by CONTRACTOR without the prior written approval of CITY. 16. COMPLIANCE WITH SPECIFICATh~NS OF MATERIALS. Whenever in the Specifications, any material or process is indicated or specified by patent or proprietary name, or by name of manufacturer, such Specifications rriust be met by CONTRACTOR, unless CITY agrees in writing to some other material, process or article offered by CONTRACTOR which is equal in all respects to the one specified. It shall be CONTRACTOR'S responsibility to prove equality of any such material, process or article offered as a substitution to the one(s) specified. 17. WORKER'S COMPENSATION INSURANCE AND EMPLOYER'S LIABILITY INSURANCE. CONTRACTOR shall take oizt and maintain during the life of this Contract Worker's Compensation Insurance and Erployer's Liability Insurance for all of CONTRACTOR'S employees employed at the site of the project. In case any work is sublet, CONTRACTOR shall require any and all s~xbcontractors similarly to provide Worker's Compensation and Employer's Liability Insurance for all of the latter's employees unless such employees are covered by the protection afforded to the CONTRACTOR. In signing this Contract CONTRACTOR makes the following certification, required by Section 1861 of the Labor Code: "I am aware of the provisions of Section 3700 of the Labor Code which 4 requires every employer to be insured against liability for worker's compensation or to undertake self insurance in accordance with the provisions of the Labor Code, and I will comply with such provisions before commencing the performance o:F the work of this Contract." 18. ACCIDENT PREVENTION. Prec~iution shall be exercised at all times for the protection of persons (including employees) and property. The safety provisions of applicable laws, building codes and construction codes shall be observed. Machinery, equipment and other hazards shall be guarded or eliminated in accordance with the safety provisions of the Construction and Safety Orders issued by the Industrial Accident Commission of the State of California. 19. CONTRACTOR'S RESPONSIBILITY FOR THE WORK. CONTRACTOR shall not be responsible for the cost of repairing or restoring damage to the work caused by Acts of God. NEVERTHELESS, CONTRACTOR shall, if the insurance premium is a separate bid item, obtain the insurance to indemnify CITY for any damage to the work caused by Acts of God. "Acts of God" shall include only the following occurrences or conditions and effects: earthquakes and tidal waves, when such occurrences or conditions and effects have been proclaimed a disaster or state of emergency by the President of the United States or by the Governor of the State of California, or were of a magnitude at the site of the work sufficient to have caused a proclamation of disaster or state of emergency having occurred in a populated area. Subject to the foregoing, CITY shall not, in any way or manner, be answerable or suffer loss, damage, expense or liability for any loss or dam;~ge that may happen to said building, work, or equipment or any part thereof, or in, on, or about the same during its construction and before acceptance. 20. CONTRACTOR'S GUARANTEE. CONTRACTOR unqualifiedly guarantees the first-class quality of all work and of all materials, apparatus and equipment used or installed by CONTRACTOR or by any subcontractor or supplier in the project which is the subject of this Contract, unless a lesser quality is expressly auth~~rized in the Plans and Specifications, in which event CONTRACTOR unqualifiedly guarantees such lesser quality; and that the work as performed by CONTRACTOR will conform with the Plans and Specifications or any written authorized deviations therefrom. In case of arty defect in the work, materials, apparatus or equipment, whether latent or patent, revealed to CITY within one (1) year of the date of acceptance of completion of this Contract by CITY, CONTRACTOR will forthwith remedy such defects without cost to CITY. 5 P.O. No. 21. DEFERRED ALTERNATE SELECTION. The City reserves the right for the term of the Contract, the deferred selection of none, any or all alternate bid items at the bid price. The alternates chosen would be for any sites currentl`~ under construction or to be constructed in the future. IN WITNESS WHEREOF, the parties have executed this Contract, in duplicate, the day and year first hereinabove written. CITY OF CiJPERTINO: CONTRACTOR: Michael Fuller Deputy City Engineer Attest: ~>1/'~~E <- ~ ~`'(~L~-~~ `~~- City Clerk i Date: ~~ ~ , 20 City Clerk APPROVED AS TO FORM: 12EPu ~t-t L ~G'f12-~G B~ .~.~.~ r~ a Notary acknowledgment is required. If a corporation, corporate seal and corporate notary acknowledgment and Federal Tax I.D. are required. If not a corporation a Social Security No. is required. Social Security # ~,g- OZ~- 6~ 2 ~- Federal Tax I.D. # Contractor's License No. ~'~"~ ~~ City Attorney Project Name & Number: SAFE ROUTES TO SIYCOOL PROGRAM, PROJECT NO. 9541 Contractor's Name & Address: REPUBLIC' ELECTRIC 7120 REDV'-'OOD BOULEVARD NOVATO, CA 94545-4114 Contract Amount: $ 299,500.00 Account Number: 420-9541-9300 File No: 74, 009.17 6 CALIFORNIA ALL-PURPOSE ACKNOVIILEDGMENT ~~~~~~ti~~~~~~~~~~~~~~~ ~~~~~ ~,~~~~~~~ State of California ~,~ n ss. County of ___ On ~. (J "~) ,before me Date personally appeared Name and Title of Officer (e.g., "Jane Doe, Notary Public") ^ll rsonally know~to me proved to me on the basis of satisfactory evidence ~. ruc~. ;~ ~ ,.. ~•a ~ ~ = r.,~' to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed tha same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or tha entity upon behalf of which the person(s) acted, executed the instrument. WIT SS my hand and official seal. Place Notary Seal Above S gn ure of Notary Pub OPTIONAL Though the information below is not required by law, it m~1y prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document: Document Date: __ Number of Pages Signer(s) Other Than Named Above: __ Capacity(ies) Claimed by Signer Signer's Name: __ Individual Top or cnUmb Here Corporate Officer -Title(s): ^ Partner - ^ Limited ^ General ^ Attorney in Fact i-J Trustee Guardian or Conservator ^ Other: __ Signer Is Representing: __ ~, © 1999 National Notary Association • 9350 De Soto Ave., P.O. Box 2402 • Chatsworth, CA 91313-2402 • www.nationalnotary.org Prod. No. 5907 Reorder: Call Toll-Free 1-800-876-6827 INSURANCE FORI~ZS INSTRUCTIONS FOR ITEMS 3, 4, 5 AND 6, THE FORMS PROVIDED BY THE CITY OF CUPERTINO MUST BE USED. FORMS OTHER THAN TIIE5E WILL NOT BE ACCEPTED. ALL DOCUMENTS MUST BE ORIGINALS -SUBMIT IN TRIPLICATE 1. Insurance Agreement -Must be signed by Contractor. 2. Certificate of .Insurance to the City of Cupertino -must be completed by the insurance agent or must provide a certificate on the a~mpany's form. They must contain the same information. 3. Endorsement of Primary Insurance -must be signed by the insurance agent for general liability and automobile liability only. 4. Additional insured endorsement -must be sig~ied by the insurance agent for general liability and automobile liability only. 5. Comprehensive general liability/commercial general liability endorsement of aggregate limits of insurance per project -must be signed by the insurance agent for general liability only. 6. Waiver of subrogation endorsement worker's compensation insurance -must be signed by the insurance agent for worker's compensation only. 7. Notice of policy cancellation endorsement - rnust be signed by the insurance agent or must be on the company's certificate of insurance form for all insurances. Insurance Instructions r 0 CUPEI~TINO INSURANCE AGREEMENT A. Contractor is 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 undertake self- insurance in accordance with the provisions of that Code, and will comply with such provisions before commencing the performance of the work ~~f this Contract. B. Contractor and all subcontractors will carry worker's compensation insurance for the protection of its employees during the progress of the work. The insurer shall waive its rights of subrogation against the City, the City's officers, agents and employees and shall issue an endorsement to the policy evidencing same. C. Contractor shall carry at all times, on all operations hereunder, commercial or comprehensive general liability insurance, automobile liability insurance and builder's all risk insurance. All insurance coverage shall be in amounts required by the City and shall be evidenced by the issuance of a certificate in a form prescribed by the City and shall be underwritten by insurance companies satisfactory to the City for all operations, sub-contract work, contractual obligations, product or completed operations, all owned vehicles and non-owned vehicles. Said insurance coverage obtained by the Contractor, excepting worker's compensation coverage, shall name the City, its engineer, and each of its directors, officers, agents and employees,.as determined by the City, as additional insureds on said policies. Insurers must be licensed to do business in the State of California. The Insurers must also have an "A" policyholder's rating and a financial rating of at least Class VII in accordance with the current Best's Guide Rating. D. Before Contractor performs any work at, or prepares or delivers materials to, the site of construction, Contractor shall furnish certificates. of insurance evidencing the foregoing insurance coverages and such certificates shall provide the name and policy number of each carrier and policy and that the insurance is in force and will not lie canceled or modified without thirty (30) days written notice to the City. Contractor shall maintain all of the foregoing insurance coverages in force until the work under this Contract is fully completed. The requirement for carrying the foregoing insurance shall not derogate from the provisions for indemnification of the City by Contractor under this Contract and for the duration of the warranty period. Notwithstanding nor diminishing the obligations of Contractor with re;~pect to the foregoing, Contractor shall maintain in full force and effect during the life of this Contract, the following insurance in amounts not less than the amounts specified and issued by a company admitted in California and having a Best's Guide ',Rating of A, Class VII or better. Worker's Compensation Liability In accordance with the Worker's Compensation Act Of the State of California - $1,000,000 per occurrence. Insurance Agreement Page 1 of 2 Public Liability -either commercial general Combined single limit of $1.0 million per liability or comprehensive general liability; occurrence; $2.0 million in the aggregate. including provisions for contractual liability, personal injury, independent contractors and property damage coverages. Automobile Liability -comprehensive covering Combined single limit of $1.0 million per owned, non-owned and hired automobiles. occurrence. Consultants only: Errors and Omissions liability. $1.0 million per occurrence. (Contractor's Name) By:_ Dated: 20 Insurance Agreement Page 2 of 2 +1 ITY F CUPEI~TINO CERTIFICATE OF INSURANCE TO THE CITY OF CUPERTINO This certifies to the City of Cupertino that the foll~~wing described policies have been issued to the insured named below and are in force at this time. Insured: Address: Description of operations/locations/products insured (show contract name and/or number, if any): ---------------------------------------------------------------------- ---------------------------------------------------------------------- WORKER'S COMPENSATION * Statutory Min. * Employer' s Liability (name of insurer) $ $ $ Insurance Company's State License No. ---------------------------------------------------------------------- ---------------------------------------------------------------------- Check Policy Type: Each Occurrence $ COMPREHENSIVE GENERAL LIABILITY [ ] Premises/Operations General Aggregate $ (if applicable) [ ] Owners & Contractors Protective [ ] Contractual for Specific Contract [ ] Products Liability [ ] XCU Hazards [ ] Broad Form P.D. [ ] Severability of Interest Clause Aggregate Perscnal Injury Fire Damage (any one fire) $ [ ] Personal Injury with Medical Expense Employee Exclusion Removed (any one person) or Self-~[nsured COMMERCIAL GENERAL LIABILITY Retention (name of insurer) Policy No. Expiration Date Certificate of Insurance A;reement Page 1 of 2 AUTOMOTIVE/VEHICLE LIABILITY BODILY INJURY Commercial Form Each Person Liability Coverage $_ Each Accident (name of insurer) $_ Combined Single Limit Policy No. Expiration Date (agent's initial) PROPERTY DAMAGE Each Accident or A copy of all Endorsements to the policy(ies) which in any way limit the above-listed types of coverage are attached to this Certificate of Insurance. This Certificate of Insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or any other document with respect to which this Certificate of Insurance may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. IT IS HEREBY CERTIFIED that the above po'iicy(ies) provide liability insurance as required by the Agreement between the City and the insured. By: Dated: 20 Attach Certificate of Insurance and Additional Insured Endorsement on company forms. Certificate of Insurance ~~greement Page 2 of 2 CUPEI~TINO ENDORSEMENT OF PRIMARY INSURANCE In consideration of the policy premium and :notwithstanding any inconsistent statement in the policy to which this Endorsement is attached or a~ly other Endorsement attached thereto, it is agreed as follows: The insurance afforded by this policy is primary insurance, and no additional insurance held or owned by the designated additional insureds) :;hall be called upon to cover a loss under said additional policy. POLICY INFORMATION 1. Insurance Company: 2. Insurance Policy Number: 3. Effective Date of this Endorsement: 20, 4. Insured: All notices herein provided to be given b}~ the Insurance Company to the City in connection with this policy and this Additional Insured Endorsement, shall be mailed to or delivered to the City at 10300 Torre Avenue; Cupertino, California 9`i014. I, ~ (print/type name) warrant that I have authority to bind the below listed Insurance Company and by my signature hereon do so bind this Company. Signature of Authorized Representative: (Original signature required on all Endorsements furnished to the District) ,Name of ~I Agent/Agency: Address: Title: Telephone: Facsimile: Primazy Endorsement Page 1 of 1 irr o CUPERTINO ADDITIONAL INSI7RED ENDORSEMENT In consideration of the policy premium and notwithstanding any inconsistent statement in the policy to which this Endorsement is attached or a:ny other Endorsement attached thereto, it is agreed as follows: The City of Cupertino ("City") and its directors, officers, engineers, agents and employees, and all public agencies from whom permits will be obtained and their directors, officers, engineers, agents and employees are hereby declared to be additional insureds under the terms of this policy, ,but only with respect to the operations of the Contractor at or upon any of the premises of the City' in connection with the Contract with the City, or acts or omissions of the additional insureds in ~, connection with, but limited to its general supervision or inspection of said operations. POLICY INFORMATION 1. Insurance Company: 2. Insurance Policy Number: 3. Effective Date of this Endorsement: 20 4. Insured: All notices herein provided to be given by the Insurance Company to the City. in connection with this policy and this Additional Insured Endorsement, shall be mailed to or delivered to the City at 10300 Torre Avenue; Cupertino, California 9_`014. I, (print/type name) warrant that I have authority to bind the below listed Insurance Company and by my signature hereon do so bind this Company. Signature of Authorized Representative: (Original signature required on all Endorsements furnished to the District) Names of AgendAgency: Title: Address: Telephone: Facsimile: Additional Insured Endorsement Page 1 of 1 F CUPEI~TINO COMPREHENSIVE (TENERAL LIABILITY COIVIIVIERCIAL GENERAL LIABILITY ENDORSEMENT OF AGGREGATE LIMITS OF INSURANCE PER PROJECT In consideration of the policy premium and notwithstanding any inconsistent statement in the policy to which this Endorsement is attached or any other Endorsement attached thereto, it is as follows: This Endorsement modifies the insurance provided under the General Liability Coverage part the below-referenced policy of insurance. The general aggregate limit under LIMITS OF INSURANCE applies separately to the project described as POLICY INFORMATION 1. Insurance Company: 2. Insurance Policy Number: 3. Effective Date of this Endorsement: 20 4. Insured: 5. Additional Insured: City of Cupertino, its directors, officers, agents and employees. All notices herein provided to be given by the Insurance Company to the City in connection with this policy and this Additional Insured Endorsement, shall be mailed to or delivered to the City ~, at 10300 Torre Avenue; Cupertino, California 9:5014. I, (print/type name) warrant that I have authority to bind the belov~~ listed Insurance Company and by my signature hereon do so bind this Company. Signature of Authorized Representative: (Original signature required on all Endorsements furnished to the District) Names of Agent/Agency: Title: Address: Telephone: Facsimile: Aggregate Limix~ Endorsement Page 1 of 1 ~' CUPEI~TINO WAIVER OF SUBROGATION ENDORSEMENT WORKER'S COMPENSATION INSURANCE In consideration of the policy premium and n~~twithstanding any inconsistent statement in the policy to which this Endorsement is attached or amp other Endorsement attached thereto, it is agreed as follows: It is agreed that with respect to such insurance as is afforded by the policy, the Insurance Company waives any right of subrogation it may require against the City of Cupertino, and each of its directors, officers, agents, consultants and employees by reason of any payment made on account of injury, including death resulting therefrom, sust:tined by any employee of the insured, arising out of the performance of the above-referenced Contract. POLICY INFORMATION 1. Insurance Company: ~ 2. Insurance Policy Number: 3. Effective Date of this Endorsement: 20 4. Insured: All notices herein provided to be given by th~~ Insurance Company to the City in connection with this policy and this Additional Insured Endorsement, shall be mailed to or delivered to the City at 10300 Torre Avenue; Cupertino, California 95C~ 14. I, (print/type name) warrant that I have authority to bind the below listed Insurance Company and by my signature hereon do so bind this Company. Signature of Authorized Representative: (Original signature required on all Endorsements furnished to the District) Names of Agent/Agency: Address: Title: Telephone: Facsimile: Subrogation Endor:~ement Page 1 of 1 CUPEI~TINO NOTICE OF POLICY CANCELLATION ENDORSEMENT In consideration of the policy premium acid notwithstanding any inconsistent statement in', the policy to which this Endorsement is attached or any other Endorsement attached thereto, it is agreed as follows: Cancellation Notice. The insurance afforded by this policy shall not be suspended, voided, canceled, reduced in coverage or in limits, or materially altered, except after thirty (30) days' prior written notice by certified mail, return receipt requested, has been given to the City of Cupertino ("City"). Such notice shall be addressed to the City as indicated below. POLICY INFORMATION 1. Insurance Company: 2. Insurance Policy Number: 3. Effective Date of this Endorsement: 20 4. All notices herein provided to be given by th.e Insurance Company to the City in connection with this policy and this Additional Insured Endorsement, shall be mailed to or delivered to the City at 10300 Torre Avenue; Cupertino, California 95014. I, (printltype name) warrant that I have authority to bind the below listed Insurance Company and by my signature, hereon do so bind this Company. Signature of Authorized Representative: (Original signature required on all Endorsements furnished to the District) Names of Agent/Agency: Title: Address: Telephone: Facsimile: Cancellation Endorsement Page 1 of 1 FAITHFUL PERF~~RMANCE BOND KNOW ALL MEN BY THESE PRESENT: THAT Principal, and Surety, (bonding company's name) as are held and firmly bound unto the City of Cupertino, State of California, in the sum of lawful money of the United States, for the payment of which will and truly to be made, we bind ourselves, our heirs, executors, successors and assigns, jointly and severally, firmly by these presents. THE CONDITION of the foregoing obligation is such that, WE, (contractor's name) WHEREAS, the Principal has entered into a contract with the City dated 20 with the obligee to do and perform the following work to-wit: NOW, THEREFORE, if the said principal shall well and truly perform the work contracted to be performed under said contract, then this obligation shall be void; otherwise to remain in full force and effect. IN WITNESS WHEREOF, this instrument has been duly executed by Principal and Surety this day of , 20__. (To be signed by Principal and Surety, Notary ack~iowledgment required) CONTRACTOR Principal Surety Street Address: City, State, Zip By: Attorney-In-Fact The above bond is accepted and approved this _day of 20_ Faithful Performance Page 1 of 1 LABOR AND 1VIE~TERIAL BOND KNOW ALL MEN BY THESE PRESENT: WHEREAS, the City of Cupertino, State of California, and hereinafter designated as "Principal" have entered into or are about to enter into a contract providing for the installation, construction, and f;rection by Principal of more particularly described in said contract; and incorporated herein by reference. WHEREAS, said principal is required to furnish a bond in connection with said contract, providing that if said Principal, or any of his or its subcontractors, shall fail to pay for materials, provisions, provender or other supplies or teams used in, upon, for or about the performance of work contracted to be done, or for any work or l~~bor done thereon of any kind, the Surety on said bond shall pay the same to the extent hereinafter s~;t forth; NOW, THEREFORE, WE, as Principal, (contractor's name) and as Surety, (bonding company's name) firmly bind ourselves, our executors, administrators, successors and assigns, jointly and severally, unto the City of Cupertino, and any and all materialmen, persons, companies, or corporations furnishing materials, provisions, provender or other supplies used in, upon, for or about the performance of the aforesaid work contracted to be executed or performed under the contract hereinabove mentioned, and incorporated herei~i by reference, and all persons, companies or corporations lending or hiring teams, implements or machinery, for or contributing to said work to be done, and all persons who perform work or l;~bor upon the same, and all persons who supply both work and materials, whose claim has not been paid by Principal or by any other person, in the just and full sum of THE CONDITION OF THIS OBLIGATION IS SUCH THAT if said principal, his or its subcontractors, heirs, executors, administrators, successors or assigns, shall fail to pay for any materials, provisions, provender or other supplies or teams used in, upon, for or about the performance of the work contracted to be done, oi• for any work or labor thereon of any kind, or for amounts due under the Unemployment Insurance ,pct with respect to such work or labor, or any and all damages arising under the original contract, then said Surety will pay the same and also will pay in case suit is brought upon this bond, such reason,~ble attorney's fee as shall be fixed by the court. This bond shall insure to the benefit of any and all persons, companies, and corporations entitled to file claims under Section 1184.1 of the Code of Civil Procedure, so as to give a right of action to them or their assigns in any suit brought upon this bond. Labor and Material Page 1 of 2 And the said Surety, for value received, hereby stipulates, and agrees that no change, extension of time, alteration or addition to the terms of the contract or to the work to be performed thereunder or the specifications accompanying the; same shall in any wise affect its obligations on this bond, and it does hereby waive notice of arty such change, extension of time, alteration or addition to the terms of the contract or to the work or to the specifications. IN WITNESS WHEREOF, this instrument has been duly executed by Principal and Surety this day of , 20__. (To be signed by Principal and Surety. Notary acknowledgments required.) CONTRACTOR Principal Surety Street Address: City, State, Zip, By: Attorney-In-Fact The above bond is accepted and approved this _day of , 20_. Labor and Material Pa ~e 2 of 2 EXHIBIT A PROPOSAL TO THE CITY COUNCIL OF THE CITY OF CUPERTINO FOP; 2001 SAFE ROUTES TO SCHOOL PROJECT City Project Z1o. 9541 Federal Program No. STPLHSR 5318(O1~ Name of Bidder: ~~~uL ~L'~-~C~ ': Business Address: ~LZO ~~ tJI~~OD SI.VD City: t~nul~Tfl Zip Code9~~ Phone: ~S 8 a - g Fax: S - ~~'~' ***** The work to be done and referenced to herein is in the City of Cupertino or the adjacent vicinity, State of California, and extends over property owned or controlled by the City of Cupertino, and is to be constructed in accordance with special provisions (including the payment of not less than the State general prevailing wages or Federal minimum wage rates referred to in the special provisions), the project plans described below, including any addenda thereto, the contract annexed hereto and also in accordance with the State Standard Specifications, Standard Plans and Standard Details of the City of Cupertino, and the Labor Surcharge and Equipment Rental Rates in effect on the date the work is accomplished, which are hereby specially referred to and by such reference made a part hereof. The work to be done is shown upon plans entitled: TITLF 2001 SAFE ROUTES TO SCHOOL PROJECT City Project T1o. 9541 Federal Aid No. STPLHSR 5318(Ol~ TO THE CITY COUNCIL, CITY OF CUPERTINO The undersigned, as bidder, does hereby declare that the only persons or parties interested in this proposal are the undersigned and this proposal is made without collusion with any other person, firm, or corporation; that he has carefully examined the location of the proposed work, th.e annexed proposed form of contract, and the plans therein referred to; and he proposes and agrees, if this proposal is accepted, that he will contract with the City of Cupertino, in the form of the copy of the contract annexed hereto, to provide all necessary machinery, tools, apparatus, and other means of construction and to do all the work and furnish all the materials specified in the contract, in the manner and the time therein prescribed, and according to the requirements of the Engineer as therein set forth, and that he will take in full payment therefor the amounts shown on the following unit price schedule, to wit: Federal Funded Project P-1 City Project No. 9541 June 2001 07/31/01 13:39 $`4087773333 CITY CLTpERTINO REVISED 6IID SHEET 2p01 SAFE ROUTES TO SCHOOL PROJECY Clty F~rojea~t No. 8541, Fodoral Pro~~ralim No. STPLHSR-6318(016) I~oo2/002 NO. ITEM DESCRIPTION OTM UNIT UNIT PRICE TOTAL (In Figuroo) 1 CURB RAMPS 4 ~ 2 ~t)O O .S Op p 2 SIDENVALK 1,150 SF l.o . b'O 3 A.C WALKWAY 1,300 SF ~ O V ~ O ~ a RAISED cRosswALK ~ Nlona Vlsn High school 1 LS ~ p 6 ~ /1 000 5 RAISED CROSSWALK ~ Fort Baker & Prosidio 1 ~ ~ b b l7 ~ O 0 b e DEMOLITION / CLEI~,RINC3 ~'~ GRUBBING 1 LS ,~ ~ f5 ~ ~ ~Jt ~G O 7 EXTINGUISHABLE NIESSAI,;E SIGN 1 -' ~ t a obl7 1 ~ 060 Tj LIGHTEp cRQSSW: ;LK SYSTEM ~ Bubb a Hysnlsport 1 L5 ~ a bob ~ol p0 0 s -Cf~SY evens ree ~, ~ ~ yg o00 ~~ 00 10 7 00 LF ~ l~ 000 11 OF LINDA VISTA DR. 1 LS `'~ CJ 0 O ~( 'SOD 12 PCC MEDIAN 1.385 8F $ ^ 1 ~ O ~ O 13 MEDIAN CURB 605 LF ~~ --~ ~ ~ o` l,} ~ 1~i FULL DEPTM ASPH~~LT PA'VINO 4,825 SF ~ . ~ O a°~ ~~ ; 15 4' WIDE PCC VALLEY GU'T'TER 90 LF ~,..`.~ ~ n ~ ~ 16 CURB ~ OUTTIrR 235 LF a$ - ~ 5 ~ o 17 TRAFFIC CONTROL 1 ~ I ~ 00'0 ~ 9 0 00 18 sioNlNO 1 LS '-( DUb ~ o00 19 6TRIPINO AND PAVF_MENI' MARKINGS 1 LS ~ ~ po0 ~ b ov a=aasa ~P-~,I3(.t L ~L'L~LT12-0 ~ x,900' GM!_ SID DOTAL ~_ t '~ C O IZ ~Z.~G~f E~ ~ 2q 9 ,boo ,~' C ML. City Project No. 9341 Federal Fwded Project P-2 7/10/01 LIST OF SUBCI~NTRACTORS The Bidder shall list the name and address of each subcontractor to whom the Bidder proposes to subcontract portions of the work, as required by the provisions in Section 2-1.054, Required Listing of Proposed Subcontractors, of the Standard Specifications. Subcontractor Name and Address Descripition of Work to be Subcontracted Amount to be Subcontracted State License Number ~.-t" c rnS t , 2 ~ 3 ~'-~ ~ \`\~\~ ~1~.11~>>8 b ~ . _ c~°i( ~°~©C7 Federal Funded Project P-4 City Project No. 9541 June 2001 (THE BIDDER'S EXECUTION ON THE SIGNATURE PORTION OF THIS PROPOSAL SHALL ALSO CONSTITUTE ~~N ENDORSEMENT AND EXECUTION OF THOSE CERTIFICATIONS WHICH ARE A PART OF THIS PROPOSAL) EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder ~~~,t,~tl L C~E~~(n-4 L ,proposed subcontractor ,hereby certifies that he has ~ , has not ,participated in a previous contract or sub~;ontract 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 Feder;~l Contract Compliance, a Federal Government contracting or administering agency, or the former Presid~:nt's Committee on Equal Employment Opportunity, all reports due under the applicable filling requirements. Note: The above certification is required by the Equal Emplcyment Opportunity Regulations of the Secretary of Labor (41 CFR 60-1.7(b) (1)), and must be submitted try 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 41 CFR 60-1.5. (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, Standard Form 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 n.ot 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. Federal Funded Project P-5 City Project No. 9541 Jnne 2001 - ~ PUBLIC CONTRACT CODE Public Contract Code Section 10285.1 Statement In accordance with Public Contract Code Section 10285.1 (Chapter 376, Stats. 1985), the bidder hereby de~cl~ares under penalty of perjury under the laws of the St~~te of California that the bidder has ,has not '° been convicted within the recedin three eazs of ass offenses referred to in that section includin an P g Y Y ~ g Y ~,~ charge of fraud, bribery, collusion, conspiracy, or any othf;r actin 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 check mark 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 crimins~l prosecution. Public Contract Code Secti~~on 10162 Questionnaire In accordance 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 ]vo y If the answer is yes, explain the circumstances in the following space. Federal Funded Project P-fi CiTy Project No. 9541 June 2001 Public Contract Code 10232 Statement In accordance with Public Contract Code Section 10232, t:~e 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. Note: The above Statement and Questionnaire are pact of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature ofthis Statement and Questionnaire. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. Federal Funded Project P-'' City Project No. 9541 June 2001 Noncollusion. Affidavit (Title 23 United States Code Section 112 and Public Contract Code Section 7106) To the CITY OF CUPERTINO, DEP~~RTMENT OF PUBLIC WORKS r; In accordance with Title 23 United States Code Section 11.2 and Public Contract Code 7106 the bidder declares that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid pricf;, or of that of any other bidder, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative ,~. thereto, or paid, and will not pay, any fee to any corporati~~n, partnership, company association, organization, ' ' bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. Note: The above Noncollusion Affidavit is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Noncollusion Affidavit. Bidders are cautioned that making a false certification may subj ect the certifier to criminal prosecution. Federal Funded Project P-!3 City Project No. 9541 June 2001 DEBARMENT AND SUSPENSION CERTIFICATION TITLE 49, CODE OF FEDERE~L REGULATIONS, 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, officf;r, 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 judgement 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. Exceptions will not necessarily result in denial of award, but will be considered in determining bidder responsibility. For any exception noted above, indicate t~elow to whom it applies, initiating agency, and dates of action. Note: 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. Federal Funded Project R9 City Project No. 9541 June 2001 NONLOBBYING I~ERTIFICATION FOR FEDERAL-A,ID 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 v~rill 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 a~~varding 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, renew~~l, 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 i 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 accordance 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 $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 all lower tier subcontracts, which exceed $100,000 and that all such subrecipients shall certify and disclose accordingly. Federal Funded Project P-loo CiTy Project No. 9541 UNE 2001 DISCLOSURE OF LOBBI~ ING ACT NIT IES r'.~vrnlctw4hicfnrmtnrlicr.Inealnhhvinn artiviti~hlRSl~ant tn31 U S C_ 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type• r a.contract D a tid'dfer/a7plcuiai ~I ~ a ifl'ral For M ater a Only: yea qer t a 4. Name and Actress of Reporting Entity: 5. if Reporting Entity in is Subawardee. Enter Prime ~ Subawardee Name and Address of Inle: Tier _-- jfknown Q Congressional District(known: Congressi I Districf#known: 6. Federal Departmentl{~gency: 7. Fed al Program NamelDescription: CFDA Namber,ifappica6le 8. Federal Action Numbeifknown: 9. Award Amounffknown: S 10. a. Name and Address of Lobbying Entity b. hdividuals Performing Servic~ludingaddressif (~hdi/idual, test name, frstnarre, MI): deferent fromNo.l0a) (attach Contnuafion Sheet(s)ifnecessaryJ 11. Amount of Payment (check allthat apply): 13. Type of Payment (check all that apply) S ___-____________ ~ actual ~ planned a. retainer 12. Form of Payment (check all that apply): a. cash b. n-khd; specify: nature ---------- 8 value _----N---_ 14. B~ief Description of Services Performed or to be performt:d and Date(s) of Service, hcluding officer(s); employee(s), or member(s) contacted, for Payment Indicated in Item11: (etfachConthuationSheet(s) ifnecessary) 15. Continuation Sheet(s) attached: s No 16. InfamationrequestedthroughthisTarm'sauthaized LyTiSe 3f US.C. Section Signature: ---~-------------_ Prin~:Narre: ----------------- Title: -------- - - ---------- Tek:phone No.: --------_ Date: _----- Federal UseClnty: Autnorited forLocel f~production SlandardFam ILL Irv. 01-03-95 Federal Funded Project P-11 City Project No. 9541 UNE 2001 INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether subawazdee or prime Federal recipient, at the initiation or receipt of covered Federal action or a material change to previous filing 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 Federal 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. 1. 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. Identify the status of the covered Federal action. 3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quan:er 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 subawazd recipient. Identify the tier of the subawazdee, e.g., the first subawazdee of the prime is the first tier. Subawazds include but aze not limited to subcontracts, subgrants and contract awazds under grants. 5. If the organization filing the report in Item 4 checks "Suk~awazdee" then enter the full name, address, city, state and zip code of the prime Federal recipient. Include Congressional District, if known. 6. Enter the name of the Federal agency making the awazd or loan commitment. Include at least one organization level below agency name, if known. For example, Department of Transportation, United States Coast Guazd. 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 <<vailable for the Federal action identification in item 1 (e.g., Request for Proposal (RFP) number, Invitation for Bid (IFB) number, grant announcement number, the contract grant. or loan awazd number, the application/proposal control nuunber 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 awazd/loan commitments for the prime entity identified in item 4 or 5. 10. (a) Enter the full name, address, city, state and zip code oi.'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) performing services and include full address if different from 10 (a). Enter Last Name, First Name and Middle Initial (Ml). 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, ent~:r the cumulative amount of payment made or planned to be made. 12. Check the appropriate box(es). Check all boxes that apply. If payment is made through an in-kind contribution, specify the nature and value of the in-kind payment. 13. Check the appropriate box(es). Check all boxes that appl~;~. If other, specify nature. 14. Provide a specific and detailed description of the services that the lobbyist has performed or will be expected to perform and the date(s) of any services rendered. Include all preparatory and related activity not just time spent in actual contact with Federal officials. Identify the Federal officer(s) or employee(s) contacted or the officers} employee(s) or Member(s) of Congress that were contacted. 15. Check whether or not a continuation sheet(s) is attached. 16. The certifying official shall sign and date the form, print lus/her name title and telephone number. Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time ' for reviewing instruction, searching existing data sources, gatherir.~g 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-LLL-Instructions Rev. 06-04-90 Federal Funded Project P-12 City Project No. 9541 UNE 2001 'The undersigned encloses her it 'dder's bon ,certified check, or cashier's check No. of the Bank, for $ ~ ~ not less than ten percent (10%) of this bid, payable to the City of Cupertino, which is given as a guarantee that the undersigned will enter Into the contract if awarded the work. The undersigned hereby certifies that this bid is genuine and not a sham or collusive or made in the interest or in behalf of any person not herein named and that the undersigned has not directly or indirectly induced or solicited any other bidder to put in a sham bid, or any other person, firm or corporation to refrain from bidding, and that the undersigned has not in any manner sought by ~~ollusion, to secure for itself an advantage of any other bid. Nature of firm (corporation, partnership, individual, etc.) and names of individual names and titles of officers of the corporation including affirmative action officer. UI~aD~ ~EJ-r'f~ , 1~es~ D~T' Ko AFFIRMATIVE\ACTION OFFICER If a corporation, organized under the laws of the State of ~-LI FOfZ.~11 A Licensed in California in a cordance with an act pproviding for the registration of Contractors. License No. L~4~-i ~~ ,Class G-1 O ' ADDENDA This Proposal is submitted with respect to the changes to the plans and specifications included in addendum number(s). 1,2. (Fill in addendum number(s) if addenda have bee~i received.) ` Warning If an addendum or addenda have been issued by the City and not noted above as being received by the bidder, this Proposal may be rejected. By my signature on this proposal I certify, under penalty of perjury under the laws of the State of California, that the foregoing questionnaire and statements of tike Public Contract Code Sections 10162, 10232 and 10285.1 aze true and correct and that the bidder has complied with the requirements of Section 8103 of the Fair Employment and Housing Commission Regulations (Chapter 5, Title 2 of the California Administrative Code.) By my signature on this proposal I further certify, under penalty of perjury under the laws of the State of California and the United States of America, that the: Noncollusion Affadavrt required under Title 23 United States Code, Section 112 and Public Contract Code Section 7106; and the Title 49 Code of Federal Regulations, Part 29 Debarment and Suspension Certification are true and correct. E. ~ Signature and Address: Zb ~E~trcs~ ~~V ~. I~yya ~ ~ o14~1~5 ' - Date: ~ 1 ~ 1 members of the firm, or Federal Funded Project P-].3 City Project No. 9541 UNE 2001 BIDDER'S BOND TO ACCOMPANY PROPOSAL Know all men by these presents: That we, , a pal and, as corporate surety, duly authorized to issue bonds in the State of California, are held firmly bpi nto the CITY OF CUPERTINO °~, 4/ in the sum of Dollars, ($_ a paid to the said City or its certain attorney, its successors and assigns; for which payment, well and be made, we bind ourselves, our heirs, r '. executors and administrators, successors or assigns, jointly and ve ly, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS That if the certain proposal of the above bounde _ to construct 2001 SAFE ROUTES TO SCHOOL PROJECT dated _, is accepted by the CITY OF CUPERTINO, and if the above bounden ~ his heirs, executors, administrators, successors and assigns, shall duly enter into and execute a contract for such construction, and shall execute and deliver the two bonds described along with the executed contract within eight (8) days, not including Sundays and legal holidays, from the date of notification that contract was awarded to the above bounden by and from the said CITY OF CUPERTINO that said contract is ready for execution, then this obligation shall become null and void; otherwise it shall be and remain in fiill force and virtue. Ilv WITNESS WHEREOF, we hereunto set our hands and seals this day of , 200_ Federzl Funded Project P-14 City Project No. 9541 IJ1VE 2001 LOCAL AGENCY BIDDER •• DBE -INFORMATION This information may be submitted with your bid proposal. Ii' it is not, and you are the apparent low bidder or the second or third low bidder, it must be submitted and received as specified in Section 2-1.OZB of the Special Provisions. Failure to submit the required DBE information will be grounds for finding the proposal nonce onsive. CO.-RTE.-Kt' CONTRACT BID AMOUN BID OPENIN BIDDER'S N~ DBE GOAL FROM CONTRACT: ilaL' DUTML' lV1NT7?A!`Tlli? (`F7?TT1~it!''ATT(1N IJ L CONTRACT ITEM OF WORK AND DBE CERT. NO. NAME OF DBEs DOLLAR ITEM NO. DESCRIPTION OR SERVICES TO (Must be certified on the date E AMOUNT DBE s BE SUBCONTRACTED OR bids are opened - mdude DB MATERIALS TO BE PROVIDED a address and hone number ``~ ~~~ ~~°t `~C EY,csc. `e.~ ~c~-~~ c ~ a°c ~°~ o0 C o~n c r ~. ~~ ~ 't r G~~. ~ L Go'n~ t-o~ IlVIPORTANT: Identify all DBE firms being claimed for credit:, Total Claimed ~ regardless of tier. -Copies of the DBE quotes are required. participation Names of the l~rst Tier DBE Subcontractors and their respective 0~ a~ ~ item(s) of work listed above shall be consistent, where applicabl'ie, 1 with the names and items of work in the "List of ~ o~a Subcontractors" submitted with your bid pursuant to the ^ Subcontractors Listing Law and Section 2-1.01, "General," of the Special Provisions. b DBE i ifi i h i E Q er. pr me e cert cat on num 1. DBE prime contractors shall enter t r DB . contractors shall indicate all work to be performed by DBEs including work perforni Sigia a of Bidder by its own forces. 2. If 100% of item is not to be performed or furnished by DBE, describe exact portion Q Q ~ ~ ~ ~ S O ' p of item to be performed or famished by DBE. (Area Code) Tel. No. 3. See Section 2-1.02, "Disadvantaged Business Enterprise," to determine the credit ~ allowed for DBE firms. ~ ~~ ~p~~ ~ Person to Corrtact Please T e or Ptint i tsiaaer - lits~ tnrormauon txev uv-~a-r~~ Federal Funded Project P-15 City Project No. 9541 iJ1VE 2001 DBE INFORMATION-GOa~D FAITH EFFORTS The City of Cupertino established a Disadvantaged Business Er.Rerprise (DBE) goal of % for this project. The information provided herein shows that adequate good faith efforts were made. A. The names and dates of each publication in which a request for DBE participation for this project was placed by the bidder (please attach copies of advertisements or proofs of publication): Publications Dates of Advertisement B. The names and dates of written notices sent to certified DBEs soliciting bids for this project and the dates and methods used for following up initial solicitations to determine with certainty whether the DBEs were interested (please attach copies of solicitations, telephone records, fax confirmations, etc.): Names of DBEs Date of Inital Follow Up Methods Solicited Solicitation and Dates C. The items of work which the bidder made available to DBI~; firms, including, where appropriate, any breaking down of the contract work items (including those items normally performed by the bidder with its own forces) into economically feasible units to facilitate DBE participation. It is the bidder's responsibility to demonstrate that sufficient work to facilitate DBE participation was made available to DBE fums. Items of Work Breakdown of Items D. The names, addresses and phone numbers of rejected DBE firms, the reasons for the bidder's rejection of the DBEs, and the firms selected for that work (please attach copies of quotes from the firms involved): Names, addresses and phone numbers of rejected DBEs and ~:he reasons for the bidder's rejection of the DBEs: Federal Funded Project P-16 City Project No. 9541 UNE 2001 Names, addresses and phone numbers of firms selected for tt~e work above: E. Efforts made to assist interested DBEs in obtaining bonding, lines of credit or insurance, and any technical assistance or information related to the plans, specifications and requireme;nts for the work which was provided to DBEs: F. Efforts made to assist interested DBEs in obtaining necessaryr equipment, supplies, materials, or related assistance or services, excluding supplies and equipment the DBE subcontractor purchases or leases from the prime contractor or its affiliate. G. The names of agencies, organizations or groups contacted to provide assistance in contacting, recruiting and using DBE firms (please attach copies of requests to agencies and any responses received, i.e., lists, Internet page download, etc.). Name of Method/Date of Results Agency/Organization Contact H. Any additional data to support a demonstration of good faith efforts (use additional sheets if necessary): Federal Funded Project P-17 City Project No. 9541 iJNE 2001