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Pro Tech Engineering Corporation
RECORDING REQUESTED BY. The City of Rancho Palos Verdes WHEN RECORDED MAIL TO: 11/13/2017 r City Clerk 1 Name City of Rancho Palos Verdes Street 30940 Hawthorne Blvd. Address Rancho Palos Verdes, CA '20171298885' City 90275 Slate Zip I- J Space above this line for recorder's use 44140LGOTTS FORMS INC =rye "`' , _._ . • NOTICE OF COMPLETION Notice pursuant to Civil Code Section 3093,must be filed within 10 days after completion. (See reverse side for complete requirements.) Notice is hereby given that. 1. The undersigned is owner or corporate officer of the owner of the interest or estate slated below in the property hereinafter described. 2 The full name of the owner is City of Rancho Palos Verdes 3. The lull address of the owner is 30940 Hawthorne Blvd., Rancho Palos Verdes,CA 90275 4. The nature of the interest or estate of the owner is:In tee. • (ii other Tear.Fee,strike'In lee'and insert.for example."purchaser under contract of purchase.'or'Lessee') 5. The full names and full addresses of all persons,it any,who hold title with the undersigned as joint tenants or as tenants in common are: NAMES ADDRESSES 6. The full names and full addresses of the predecessors in interest of the undersigned, if the property was transferred subsequent to the commencement of the work or improvements herein referred to: NAMES ADDRESSES • 7. A work of improvement on the property hereinafter described was completed on April 19,2017 .The work done was: Hawthorne Blvd.Traffic Signal Synchronization Project-Federal Project No. HSIPL-5413(014) 8. The names of the contractor,if any,for such work of improvement was Pro Tech Engineering Corp. (If no contractor for work of improvement as a whole.insert'None") (Date of Contract) 9. The property on which said work of improvement was completed is in the City of Rancho Palos Verdes County of Los Angeles , State of CA ,and is described as follows: along Hawthorne Blvd. 10. The street address of said properly is Hawthorne Blvd.from 31186 Hawthorne Blvd.to 27803 Hawthorne Blvd. (II no street address has been offioally assigned.insert'none'.) °\\\--) Dated (Signature of Owner or corporate officer of Owner named In paragraph 2,or his agent) VERIFICATION I,the undersigned,say:I am the City Clerk ,Iho Declarant of the foregoing Notice of Completion; (President of.Manager of.Partne{of er of.etc.) I have read said Notice of Completion and know the contents th&ce,the same is true to my own knowledge. I declare under penalty of perjury that the foregoing is true and corr ct. Executed on Y ,20 17 at Cit of, t*_cho Palos Verdes (Personal sig - o is swea.:ng that the Coolants of the Notice of Completion are true) Before you use this form, fill in all blanks, and make whatever changes are appropriate and necessary illIII�IIIIII) to your particular transaction. Consult a lawyer if you doubt the forms fitness for your purpose and use. AAI u Wolcotts makes no representation or warranty, express or implied, with respect to the merchantability T 67775 01114II' or fitness of this form for an intended use or purpose 02005 WOLCOTTS FORMS,INC. �—1 FORM 1114 Rev.10-05 AThis page document � 9,A.-10,40.4.4., 20171298885 + 04 -4 '4'1; 11111011111111111111111111111111111 PgE: 41;1` + Recorded/Filed in official Records 7 Recorders Office Los An California w�. � ,nun, AT o.,nM FEES: 0.00 TAXES: 0.00 OTHER: 0.00 PAID: 0.00 1111 II 11110 I 1111 111111111111011111111 LEADSHEET 111011 1111 110 201711133290 30 000144960 6 III IH III ID III Dl Il II III I UI SEQ: 01 IIIIuM1i�nua01umniiiiii�io ni � 1110111101011111111111mr11niiiuriiiumu CITY OF RANCHO PALOS VERDES CONTRACT FOR: HAWTHORNE BLVD SIGNAL SYNCHRONIZATION PROJECT FEDERAL PROJECT NO. HSIPL-5413(014) THIS AGREEMENT is made and entered this 34 day of M,oncln 2016, by and between the CITY OF RANCHO PALOS VERDES, hereinafter referred to as "City" and Pro Tech Engineering Corporation, hereinafter referred to as "Contractor." WITNESSETH: WHEREAS, Contractor and Contractor's Surety are providing the bonds attached hereto and incorporated by this reference,and WHEREAS, City desires to contract with Contractor to perform the services detailed in this contract, including the Proposal, and WHEREAS, Contractor has represented that it is fully qualified to assume and discharge such responsibility; NOW,THEREFORE,the parties hereto do agree as follows: 1. Scope of Services. City hereby employs Contractor to perform the work and provide the services and materials for the project identified as: HAWTHORNE BLVD SIGNAL SYNCHRONIZATION PROJECT, FEDERAL PROJECT NO. HSIPL-5413(014), as described in the Plans and Specifications, attached hereto and incorporated herein by this reference, including miscellaneous appurtenant work. Such work shall be performed in a good and workmanlike manner, under the terms as stated herein and in these Plans and Specifications, and in accordance with the latest edition of the Joint Cooperative Committee, Southern California Chapters of the American Public Works Association and the Associated General Contractors of America, document entitled "Standard Specifications." In the event of any conflict between the terms of this agreement and any of the above-referenced documents, the terms of this agreement shall be controlling. 2. Compensation. In consideration of the services rendered hereunder, Contractor shall be paid according to the prices as submitted on the Bid Sheet of the Proposal, attached hereto as a part of the Plans and Specifications and in accordance with the Special Provisions. A retention of five percent(5%) shall be held from each payment as a contract retention to be paid as part of the final payment upon satisfactory completion of the services. 3. Independent Contractor. It is specifically understood and agreed by all parties hereto that Contractor is, for the purposes of this Agreement, an independent contractor and not an employee of the City. Accordingly, Contractor shall not be deemed the City's employee for any purpose whatsoever. Contractor shall not incur or have the power to incur any debt, obligation or liability whatever for or against City. 01203.0006/297473.2 Spc09-43 C - 1 4. Assignment. This agreement may not be assigned by Contractor, in whole or in part, without the prior written consent of City. 5. Termination. This Agreement may be canceled by City at any time without penalty upon thirty (30) days' written notice. In the event of termination without fault of Contractor, City shall pay Contractor for all services rendered prior to date of termination, and such payment shall be in full satisfaction of all services rendered hereunder. 6. Workers' Compensation Insurance. California Labor Code Sections 1860 and 3700 provide that every contractor will be required to secure the payment of compensation to its employees. In accordance with the provisions of California Labor Code Section 1861, the Contractor hereby certifies as follows: "I am aware of the provisions of Section 3700 of the Labor Code which require 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 contract." 7. Prevailing Wages. CONTRACTOR acknowledges the provisions of the State Labor Code requiring every employer to be insured against liability for workers' compensation, or to undertake self-insurance in accordance with the provisions of that code and certifies compliance with such provisions. CONTRACTOR further acknowledges the provisions of the State Labor Code requiring every employer to pay at least the minimum prevailing rate of per diem wages for each craft, classification, or type of workman needed to execute this contract. CONTRACTOR further acknowledges that this is a federally assisted construction contract and that federal labor standards provisions, including prevailing wage requirements of the Davis-Bacon and Related Acts, will be enforced. CONTRACTOR understands that in the event of a conflict between the Federal General Wage Decision as established by the United States Department of Labor (available at www.access.gpo.gov/davisbacon/ca.html) and the State General Prevailing Wage Determination as established by the California Department of Industrial Relations (available at http://www.dir.ca.gov/DLSR/PWD/index.htm),the higher of the two will prevail. 8. Suit; Recovery of Attorney Fees & Costs. Should either party bring any action to protect or enforce its rights hereunder, the prevailing party in such action shall be entitled to recover, in addition to all other relief, its reasonable attorneys' fees and court costs. (signatures on following page) 01203.0006/297473.2 Spc09-43 C -2 IN WITNESS WHEREOF, the parties hereto have executed the within Agreement the day and year first above written. CITY OF RANCHO PALOS VERDES � By: � OP May, ATTEST: -4->L&C-74CA-Aeg-jt By: City Clerk CONTRACTOR: By: `v /f /4W-1 6�3 o1a/� Printed Name Date 01203.0006/297473.2 Spc09-43 C -3 CITY OF RANCHO PALOS VERDES INSTRUCTIONS FOR EXECUTION OF INSTRUMENTS THIS IS INSTRUCTION ONLY - IT IS NOT TO BE SIGNED OR USED IN CONJUNCTION WITH THE AGREEMENT OR ANY OTHER FORMS THAT MUST BE TURNED INTO THE CITY OF RANCHO PALOS VERDES - IT IS SIMPLY A FORMAT TO USE WHEN FILLING OUT DOCUMENTS. 1. By an Individual. The individual must sign the instrument, and if he/she is doing business under a fictitious name,the fictitious name must be set forth. The signature must be acknowledged before a Notary Public,using the proper form of acknowledgment. 2. By a Partnership. The name of the partnership must be set forth followed by the signatures of less than all of the partners will be acceptable only if submitted with evidence of authority to act on behalf of the partnership. The signatures must be acknowledged before a Notary Public,using the proper form of acknowledgment. 3. By a Corporation. The name of the corporation must be set forth,followed by the signatures of the President or Vice President and Secretary or Assistant Secretary. The signatures must be acknowledged before a Notary Public,using in substance the following form of acknowledgment. 4. By a Surety. The name of the surety must be set forth, followed by an authorized signature. The signatures must be acknowledged before a Notary Public, using the proper form of acknowledgment. STATE OF 0a64-44 f et, ) SS. COUNTY OF OPAL i ) On Af'" J' 7 r , 20 4, before me, c. e/rr 4 /C4'v f , personally appeared A/1114-G /0 f 1419-1-- who proved to me on the basis of satisfactory to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies),and that by his/her/their signature(s)on the instrument the person(s),or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my signature and seal. SOHELA KAIDI (seal) Commission;r 2025876 r IP*11-1,-- i t ;M Notary Public-California Notary Public Z ??� Orange County My Comm.Ezpites Jun 2_0,20_1 Spc09-43 C -3 INSURANCE REQUIREMENTS FOR CITY OF RANCHO PALOS VERDES PUBLIC WORKS CONTRACT The Contractor shall at all time during the term of this Agreement carry, maintain, and keep in full force and effect, with an insurance company admitted to do business in California and approved by the City(1) a policy or policies of broad-form comprehensive general liability insurance with minimum limits of $5,000,000.00 combined single limit coverage against any injury, death, loss, or damage as a result of wrongful or negligent acts by the Contractor, its officers, employees, agents, and independent contractors in performance of services under this Agreement; (2)property damage insurance with a minimum limit of $1,000,000.00; (3) automotive liability insurance with a minimum combined single limits coverage of $5,000,000.00; and (4) workers' compensation insurance with a minimum limit of$1,000,000.00 or the amount required by law, whichever is greater. The City, its officers, employees,attorneys, and volunteers shall be named as additional insured on the policy(ies) as to comprehensive general liability, property damage, and workers' compensation coverages. 1. Acceptable insurance coverage shall be placed with carriers admitted to write insurance in California, or carriers with a rating of, or equivalent to, A:VII by A.M. Best & Company. Any deviation from this rule shall require specific approval, in writing, from the City. 2. All insurance policies shall provide that the insurance coverage shall not be non-renewed, canceled, reduced, or otherwise modified (except through addition of additional insured to the policy) by the insurance carrier without the insurance carrier giving the City thirty (30) days prior written notice thereof The Contractor agrees that it will not cancel, reduce or otherwise modify said insurance coverage. 3. The Contractor agrees that if it does not keep the aforesaid insurance in full force and effect, and such insurance is available at a reasonable cost, the City may take out the necessary insurance and pay the premium thereon, and the repayment thereof shall be deemed an obligation of the Contractor and the cost of such insurance may be deducted, at the option of the City, from payments due the Contractor. 4. The Contractor shall submit to the City (1) insurance certificates indicating compliance with the minimum workers' compensation insurance requirements above, and (2) insurance policy endorsements above, not less than one (1) day prior to beginning of performance under this Agreement. Endorsements must be executed on the City's appropriate standard forms entitled "Additional Insured Endorsement," copies of which are attached hereto. 01203.0006/297473.2 Spc09-43 C -5 AGREEMENT TO COMPLY WITH CALIFORNIA LABOR LAW REQUIREMENTS The undersigned Contractor certifies that it is aware of and hereby agrees to fully comply with the following provisions of California law: 1. Public Work. The work to be performed under this Agreement is a "public work" as defined in Labor Code Section 1720 and this Agreement is therefore subject to the requirements of Division 2, Part 7, Chapter 1 (commencing with Section 1720) of the California Labor Code relating to public works contracts and the rules and regulations established by the Department of Industrial Relations ("DIR") implementing such statutes. The work performed under this Agreement is subject to compliance monitoring and enforcement by the DIR. Contractor shall post job site notices, as prescribed by regulation. 2. Prevailing Wages. Contractor shall pay prevailing wages to the extent required by Labor Code Section 1771. Pursuant to Labor Code Section 1773.2,copies of the prevailing rate of per diem wages are on file at City Hall and will be made available to any interested party on request. By initiating any work under this Agreement, Contractor acknowledges receipt of a copy of the Department of Industrial Relations (DIR) determination of the prevailing rate of per diem wages, and Contractor shall post a copy of the same at each job site where work is performed under this Agreement. 3. Penalty for Failure to Pay Prevailing Wages. Contractor shall comply with and be bound by the provisions of Labor Code Sections 1774 and 1775 concerning the payment of prevailing rates of wages to workers and the penalties for failure to pay prevailing wages. The Contractor shall, as a penalty to the City, forfeit two hundred dollars ($200) for each calendar day, or portion thereof, for each worker paid less than the prevailing rates as determined by the DIR for the work or craft in which the worker is employed for any public work done pursuant to this Agreement by Contractor or by any subcontractor. 4. Payroll Records. Contractor shall comply with and be bound by the provisions of Labor Code Section 1776, which requires Contractor and each subcontractor to: keep accurate payroll records and verify such records in writing under penalty of perjury, as specified in Section 1776; certify and make such payroll records available for inspection as provided by Section 1776; and inform the City of the location of the records. 5. Apprentices. Contractor shall comply with and be bound by the provisions of Labor Code Sections 1777.5, 1777.6, and 1777.7 and California Code of Regulations Title 8, Section 200 et seq. concerning the employment of apprentices on public works projects. Contractor shall be responsible for compliance with these aforementioned Sections for all apprenticeable occupations. Prior to commencing work under this Agreement,Contractor shall provide City with a copy of the information submitted to any applicable apprenticeship program. Within sixty (60) days after concluding work pursuant to this Agreement, Contractor and each of its subcontractors shall submit to the City a verified statement of the journeyman and apprentice hours performed under this Agreement. 6. Eight-Hour Work Day. Contractor acknowledges that eight (8) hours labor constitutes a legal day's work. Contractor shall comply with and be bound by Labor Code Section 1810. 7. Penalties for Excess Hours. Contractor shall comply with and be bound by the provisions of Labor Code Section 1813 concerning penalties for workers who work excess hours. The Contractor shall, as a penalty to the City,forfeit twenty-five dollars($25) for each worker employed in the performance of this Agreement by the Contractor or by any subcontractor for each calendar day during which such worker is required or permitted to work more than eight(8)hours in any one calendar day and forty(40) 01203.0006/297473.2 Spc09-43 C - 11 hours in any one calendar week in violation of the provisions of Division 2,Part 7, Chapter 1,Article 3 of the Labor Code. Pursuant to Labor Code section 1815, work performed by employees of Contractor in excess of eight (8) hours per day, and forty (40) hours during any one week shall be permitted upon public work upon compensation for all hours worked in excess of 8 hours per day at not less than one and one-half(11/2)times the basic rate of pay. 8. Workers' Compensation. California Labor Code Sections 1860 and 3700 provide that every employer will be required to secure the payment of compensation to its employees if it has employees. In accordance with the provisions of California Labor Code Section 1861,Contractor certifies as follows: "I am aware of the provisions of Section 3700 of the Labor Code which require 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 contract." 9. Contractor's Responsibility for Subcontractors. For every subcontractor who will perform work under this Agreement, Contractor shall be responsible for such subcontractor's compliance with Division 2, Part 7, Chapter 1 (commencing with Section 1720) of the California Labor Code, and shall make such compliance a requirement in any contract with any subcontractor for work under this Agreement. Contractor shall be required to take all actions necessary to enforce such contractual provisions and ensure subcontractor's compliance, including without limitation, conducting a review of the certified payroll records of the subcontractor on a periodic basis or upon becoming aware of the failure of the subcontractor to pay his or her workers the specified prevailing rate of wages. Consultant shall diligently take corrective action to halt or rectify any such failure by any subcontractor. Date çflky' /9; 10/' Signature irtz., �� 01203.0006/297473.2 Spc09-43 C - 12 INDEMNIFICATION AND HOLD HARMLESS AGREEMENT AND WAIVER OF SUBROGATION AND CONTRIBUTION Contract/Agreement/License/Permit No.o.or description: ,/1.47a-Y7-17/6006. vD . i V �O �1 N i I. la- • Indemnitor(s) (list all names): / r J' i ♦ a AMP �L To the fullest extent permitted by law, Indemnitor hereby agrees, at its sole cost and expense, to defend, protect, indemnify, and hold harmless the City of Rancho Palos Verdes and its elected officials, officers, attorneys, agents, employees, volunteers, successors, and assigns (collectively "Indemnitees") from and against any and all damages, costs, expenses, liabilities, claims, demands, causes of action, proceedings, expenses,judgments,penalties, liens, and losses of any nature whatsoever, including fees of accountants, attorneys, or other professionals and all costs associated therewith (collectively "Liabilities"), arising or claimed to arise, directly or indirectly, out of, in connection with, resulting from, or related to any act, failure to act, error, or omission of Indemnitor or any of its officers, agents, servants, employees, subcontractors, materialmen, suppliers or their officers, agents, servants or employees, arising or claimed to arise, directly or indirectly, out of, in connection with, resulting from, or related to the above- referenced contract, agreement, license, or permit (the "Agreement") or the performance or failure to perform any term, provision, covenant, or condition of the Agreement, including this indemnity provision. This indemnity provision is effective regardless of any prior, concurrent, or subsequent active or passive negligence by Indemnitees and shall operate to fully indemnify Indemnitees against any such negligence. This indemnity provision shall survive the termination of the Agreement and is in addition to any other rights or remedies which Indemnitees may have under the law. Payment is not required as a condition precedent to an Indemnitee's right to recover under this indemnity provision, and an entry of judgment against an Indemnitee shall be conclusive in favor of the Indemnitee's right to recover under this indemnity provision. Indemnitor shall pay Indemnitees for any attorney's fees and costs incurred in enforcing this indemnification provision. Notwithstanding the foregoing, nothing in this instrument shall be construed to encompass (a) Indemnitees' sole negligence or willful misconduct to the limited extent that the underlying Agreement is subject to Civil Code 2782(a) or (b) the contracting public agency's active negligence to the limited extent that the underlying Agreement is subject to Civil Code 2782(b). This indemnity is effective without reference to the existence or applicability of any insurance coverages which may have been required under the Agreement or any additional insured endorsements which may extend to Indemnitees. Indemnitor, on behalf of itself and all parties claiming under or through it, hereby waives all rights of subrogation and contribution against the Indemnitees, while acting within the scope of their duties, from all claims, losses and liabilities arising out of or incident to activities or operations performed by or on behalf of the Indemnitor regardless of any prior, concurrent, or subsequent active or passive negligence by the Indemnitees. In the event there is more than one person or entity named in the Agreement as an Indemnitor, then all obligations,liabilities,covenants and conditions under this instrument shall be joint and several. (signatures on following page) 01203.0006/297473.2 Spc09-43 C - 13 "Indemnitor" . 1 Name Name /i'l/i1C 1' All xj(1, FS • By: By: 444_ 1 Its is 01203.0006/297473.2 Spc09-43 C - 14 DLA-OB 12-05 Attachment 1 — LAPM Exhibit 12-E, Attachment B FHWA-1273— Revised May 1,2012 REQUIRED CONTRACT PROVISIONS FEDERAL-AID CONSTRUCTION CONTRACTS I. General 3. A breach of any of the stipulations contained in these II. Nondiscrimination Required Contract Provisions may be sufficient grounds for III. Nonsegregated Facilities withholding of progress payments,withholding of final payment, IV. Davis-Bacon and Related Act Provisions termination of the contract,suspension/debarment or any other V. Contract Work Hours and Safety Standards Act action determined to be appropriate by the contracting agency Provisions and FHWA. VI. Subletting or Assigning the Contract VII. Safety:Accident Prevention 4. Selection of Labor:During the performance of this contract, VIII. False Statements Concerning Highway Projects the contractor shall not use convict labor for any purpose IX. Implementation of Clean Air Act and Federal Water within the limits of a construction project on a Federal-aid Pollution Control Act highway unless it is labor performed by convicts who are on X. Compliance with Governmentwide Suspension and parole,supervised release,or probation. The term Federal-aid Debarment Requirements highway does not include roadways functionally classified as Xl. Certification Regarding Use of Contract Funds for local roads or rural minor collectors. Lobbying ATTACHMENTS II. NONDISCRIMINATION A.Employment and Materials Preference for Appalachian The provisions of this section related to 23 CFR Part 230 are Development Highway System or Appalachian Local Access applicable to all Federal-aid construction contracts and to all Road Contracts(included in Appalachian contracts only) related construction subcontracts of$10,000 or more. The provisions of 23 CFR Part 230 are not applicable to material supply,engineering,or architectural service contracts. I. GENERAL In addition,the contractor and all subcontractors must comply 1. Form FHWA-1273 must be physically incorporated in each with the following policies:Executive Order 11246,41 CFR 60, construction contract funded under Title 23(excluding emergency 29 CFR 1625-1627,Title 23 USC Section 140,the contracts solely intended for debris removal). The contractor(or Rehabilitation Act of 1973, as amended(29 USC 794),Title VI of subcontractor)must insert this form in each subcontract and the Civil Rights Act of 1964,as amended,and related regulations further require its inclusion in all lower tier subcontracts including 49 CFR Parts 21,26 and 27;and 23 CFR Parts 200, (excluding purchase orders, rental agreements and other 230,and 633. agreements for supplies or services). The contractor and all subcontractors must comply with: the The applicable requirements of Form FHWA-1273 are requirements of the Equal Opportunity Clause in 41 CFR 60- incorporated by reference for work done under any purchase 1.4(b)and,for all construction contracts exceeding$10,000, order, rental agreement or agreement for other services. The the Standard Federal Equal Employment Opportunity prime contractor shall be responsible for compliance by any Construction Contract Specifications in 41 CFR 60-4.3. subcontractor,lower-tier subcontractor or service provider. Note:The U.S.Department of Labor has exclusive authority to Form FI-IWA-1273 must be included in all Federal-aid design- determine compliance with Executive Order 11246 and the build contracts, in all subcontracts and in lower tier subcontracts policies of the Secretary of Labor including 41 CFR 60,and 29 (excluding subcontracts for design services,purchase orders, CFR 1625-1627. The contracting agency and the FHWA have rental agreements and other agreements for supplies or the authority and the responsibility to ensure compliance with services). The design-builder shall be responsible for Title 23 USC Section 140,the Rehabilitation Act of 1973,as compliance by any subcontractor,lower-tier subcontractor or amended(29 USC 794),and Title VI of the Civil Rights Act of service provider. 1964,as amended,and related regulations including 49 CFR Parts 21,26 and 27;and 23 CFR Parts 200,230,and 633. Contracting agencies may reference Form FHWA-1273 in bid proposal or request for proposal documents,however,the Form The following provision is adopted from 23 CFR 230,Appendix FHWA-1273 must be physically incorporated(not referenced)in A,with appropriate revisions to conform to the U.S. all contracts,subcontracts and lower-tier subcontracts(excluding Department of Labor(US DOL)and FHWA requirements. purchase orders,rental agreements and other agreements for supplies or services related to a construction contract). 1.Equal Employment Opportunity: Equal employment opportunity(EEO)requirements not to discriminate and to take 2. Subject to the applicability criteria noted in the following affirmative action to assure equal opportunity as set forth sections,these contract provisions shall apply to all work under laws,executive orders,rules,regulations(28 CFR 35, performed on the contract by the contractor's own organization 29 CFR 1630,29 CFR 1625-1627,41 CFR 60 and 49 CFR 27) and with the assistance of workers under the contractor's and orders of the Secretary of Labor as modified by the provisions immediate superintendence and to all work performed on the prescribed herein,and imposed pursuant to 23 contract by piecework,station work,or by subcontract. U.S.C. 140 shall constitute the EEO and specific affirmative action standards for the contractor's project activities under Spc09-43 C - 15 this contract.The provisions of the Americans with Disabilities 4.Recruitment:When advertising for employees,the contractor Act of 1990(42 U.S.C. 12101 et seq.)set forth under 28 CFR will include in all advertisements for employees the notation:"An 35 and 29 CFR 1630 are incorporated by reference in this Equal Opportunity Employer." All such advertisements will be contract.In the execution of this contract,the contractor placed in publications having a large circulation among minorities agrees to comply with the following minimum specific and women in the area from which the project work force would requirement activities of EEO: normally be derived. a.The contractor will work with the contracting agency and a. The contractor will,unless precluded by a valid bargaining the Federal Government to ensure that it has made every agreement,conduct systematic and direct recruitment through good faith effort to provide equal opportunity with respect to all of public and private employee referral sources likely to yield its terms and conditions of employment and in their review qualified minorities and women. To meet this requirement,the of activities under the contract. contractor will identify sources of potential minority group employees,and establish with such identified sources b.The contractor will accept as its operating policy the procedures whereby minority and women applicants may be following statement: referred to the contractor for employment consideration. "It is the policy of this Company to assure that applicants are b. In the event the contractor has a valid bargaining agreement employed,and that employees are treated during employment, providing for exclusive hiring hall referrals,the contractor is without regard to their race,religion,sex,color,national origin, expected to observe the provisions of that agreement to the extent age or disability. Such action shall include:employment, that the system meets the contractor's compliance with EEO upgrading,demotion,or transfer;recruitment or recruitment contract provisions. Where implementation of such an agreement advertising;layoff or termination;rates of pay or other forms of has the effect of discriminating against minorities or women,or compensation;and selection for training,including obligates the contractor to do the same,such implementation apprenticeship,pre-apprenticeship,and/or on-the-job training." violates Federal nondiscrimination provisions. 2. EEO Officer:The contractor will designate and make known c. The contractor will encourage its present employees to to the contracting officers an EEO Officer who will have the refer minorities and women as applicants for employment. responsibility for and must be capable of effectively administering Information and procedures with regard to referring such and promoting an active EEO program and who must be applicants will be discussed with employees. assigned adequate authority and responsibility to do so. 5.Personnel Actions:Wages,working conditions,and 3. Dissemination of Policy:All members of the contractor's employee benefits shall be established and administered,and staff who are authorized to hire,supervise,promote,and personnel actions of every type,including hiring,upgrading, discharge employees,or who recommend such action,or who promotion,transfer,demotion,layoff,and termination,shall be are substantially involved in such action,will be made fully taken without regard to race,color,religion,sex, national origin, cognizant of,and will implement,the contractor's EEO policy and age or disability. The following procedures shall be followed: contractual responsibilities to provide EEO in each grade and classification of employment. To ensure that the above a. The contractor will conduct periodic inspections of project agreement will be met,the following actions will be taken as a sites to insure that working conditions and employee facilities do minimum: not indicate discriminatory treatment of project site personnel. a. Periodic meetings of supervisory and personnel office b. The contractor will periodically evaluate the spread of employees will be conducted before the start of work and then wages paid within each classification to determine any not less often than once every six months, at which time the evidence of discriminatory wage practices. contractor's EEO policy and its implementation will be reviewed and explained. The meetings will be conducted by the EEO c. The contractor will periodically review selected personnel Officer. actions in depth to determine whether there is evidence of discrimination. Where evidence is found,the contractor will b. All new supervisory or personnel office employees will be promptly take corrective action. If the review indicates that the given a thorough indoctrination by the EEO Officer,covering discrimination may extend beyond the actions reviewed,such all major aspects of the contractor's EEO obligations within thirty corrective action shall include all affected persons. days following their reporting for duty with the contractor. d. The contractor will promptly investigate all complaints of c. All personnel who are engaged in direct recruitment for the alleged discrimination made to the contractor in connection with project will be instructed by the EEO Officer in the contractor's its obligations under this contract,will attempt to resolve such procedures for locating and hiring minorities and women. complaints,and will take appropriate corrective action within a reasonable time. If the investigation indicates that the d. Notices and posters setting forth the contractor's EEO policy discrimination may affect persons other than the complainant, will be placed in areas readily accessible to employees, such corrective action shall include such other persons. Upon applicants for employment and potential employees. completion of each investigation,the contractor will inform every complainant of all of their avenues of appeal. e. The contractor's EEO policy and the procedures to implement such policy will be brought to the attention of 6.Training and Promotion: employees by means of meetings,employee handbooks,or other appropriate means. a. The contractor will assist in locating,qualifying,and increasing the skills of minorities and women who are Spc09-43 C - 16 applicants for employment or current employees. Such efforts with the requirements for and comply with the Americans with should be aimed at developing full journey level status employees Disabilities Act and all rules and regulations established there in the type of trade or job classification involved. under. Employers must provide reasonable accommodation in all employment activities unless to do so would cause an b. Consistent with the contractor's work force requirements undue hardship. and as permissible under Federal and State regulations,the contractor shall make full use of training programs,i.e., 9.Selection of Subcontractors,Procurement of Materials apprenticeship,and on-the-job training programs for the and Leasing of Equipment:The contractor shall not geographical area of contract performance. In the event a discriminate on the grounds of race,color, religion,sex,national special provision for training is provided under this contract,this origin,age or disability in the selection and retention of subparagraph will be superseded as indicated in the special subcontractors,including procurement of materials and leases of provision. The contracting agency may reserve training equipment. The contractor shall take all necessary and positions for persons who receive welfare assistance in reasonable steps to ensure nondiscrimination in the accordance with 23 U.S.C. 140(a). administration of this contract. c. The contractor will advise employees and applicants for a. The contractor shall notify all potential subcontractors and employment of available training programs and entrance suppliers and lessors of their EEO obligations under this contract. requirements for each. b. The contractor will use good faith efforts to ensure d. The contractor will periodically review the training and subcontractor compliance with their EEO obligations. promotion potential of employees who are minorities and women and will encourage eligible employees to apply for such training and promotion. 10. Assurance Required by 49 CFR 26.13(b): 7.Unions:If the contractor relies in whole or in part upon unions a. The requirements of 49 CFR Part 26 and the State DOT's as a source of employees,the contractor will use good faith U.S. DOT-approved DBE program are incorporated by efforts to obtain the cooperation of such unions to increase reference. opportunities for minorities and women. Actions by the contractor,either directly or through a contractor's association b. The contractor or subcontractor shall not discriminate on acting as agent,will include the procedures set forth below: the basis of race,color,national origin,or sex in the performance of this contract. The contractor shall carry out applicable a. The contractor will use good faith efforts to develop,in requirements of 49 CFR Part 26 in the award and administration cooperation with the unions,joint training programs aimed toward of DOT-assisted contracts. Failure by the contractor to carry out qualifying more minorities and women for membership in the these requirements is a material breach of this contract,which unions and increasing the skills of minorities and women so that may result in the termination of this contract or such other remedy they may qualify for higher paying employment. as the contracting agency deems appropriate. b. The contractor will use good faith efforts to incorporate an 11.Records and Reports:The contractor shall keep such EEO clause into each union agreement to the end that such union records as necessary to document compliance with the EEO will be contractually bound to refer applicants without regard to requirements. Such records shall be retained for a period of their race,color,religion,sex, national origin,age or disability. three years following the date of the final payment to the contractor for all contract work and shall be available at c. The contractor is to obtain information as to the referral reasonable times and places for inspection by authorized practices and policies of the labor union except that to the representatives of the contracting agency and the FHWA. extent such information is within the exclusive possession of the labor union and such labor union refuses to furnish such a. The records kept by the contractor shall document the information to the contractor,the contractor shall so certify to 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 d. In the event the union is unable to provide the contractor with classification on the project; a 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 independent recruitment efforts,fill the employment vacancies with unions,when applicable,to increase employment without regard to race,color, religion,sex, national origin,age or opportunities for minorities and women;and disability;making full efforts to obtain qualified and/or qualifiable minorities and women. The failure of a union to provide sufficient (3)The progress and efforts being made in locating, hiring, referrals(even though it is obligated to provide exclusive referrals training,qualifying,and upgrading minorities and women; under the terms of a collective bargaining agreement)does not relieve the contractor from the requirements of this paragraph. In b. The contractors and subcontractors will submit an annual the event the union referral practice prevents the contractor from report to the contracting agency each July for the duration of the meeting the obligations pursuant to Executive Order 11246,as project,indicating the number of minority,women,and amended,and these special provisions,such contractor shall non-minority group employees currently engaged in each work immediately notify the contracting agency. classification required by the contract work. This information is to be reported on Form FHWA-1391. The staffing data should 8. Reasonable Accommodation for Applicants/ represent the project work force on board in all or any part of Employees with Disabilities: The contractor must be familiar the last payroll period preceding the end of July. If on-the-job training is being required by special provision,the contractor Spc09-43 C - 17 will be required to collect and report training data. The of paragraph 1.d.of this section;also,regular contributions made employment data should reflect the work force on board during all or costs incurred for more than a weekly period(but not less or any part of the last payroll period preceding the end of July. often than quarterly)under plans,funds,or programs which cover the particular weekly period,are deemed to be constructively made or incurred during such weekly period.Such laborers and III.NONSEGREGATED FACILITIES mechanics shall be paid the appropriate wage rate and fringe benefits on the wage determination for the classification of work This provision is applicable to all Federal-aid construction actually performed,without regard to skill,except as provided in contracts and to all related construction subcontracts of 29 CFR 5.5(a)(4).Laborers or mechanics performing work in $10,000 or more. more than one classification may be compensated at the rate specified for each classification for the time actually worked The contractor must ensure that facilities provided for employees therein: Provided,That the employer's payroll records accurately are provided in such a manner that segregation on the basis of set forth the time spent in each classification in which work is race,color,religion,sex,or national origin cannot result. The performed. contractor may neither require such segregated use by written or The wage determination(including any additional classification oral policies nor tolerate such use by employee custom. The and wage rates conformed under paragraph 1.b.of this section) contractor's obligation extends further to ensure that its and the Davis-Bacon poster(WH-1321)shall be employees are not assigned to perform their services at any posted at all times by the contractor and its subcontractors at location,under the contractor's control,where the facilities are the site of the work in a prominent and accessible place where it segregated. The term"facilities"includes waiting rooms,work can be easily seen by the workers. areas,restaurants and other eating areas,time clocks, restrooms, washrooms,locker rooms,and other storage or dressing areas, b.(1)The contracting officer shall require that any class of parking lots,drinking fountains, recreation or entertainment areas, laborers or mechanics, including helpers,which is not listed in the transportation,and housing wage determination and which is to be employed under the provided for employees. The contractor shall provide separate or contract shall be classified in conformance with the wage single-user restrooms and necessary dressing or sleeping areas determination.The contracting officer shall approve an additional to assure privacy between sexes. classification and wage rate and fringe benefits therefore only when the following criteria have been met: IV. DAVIS-BACON AND RELATED ACT PROVISIONS (i)The work to be performed by the classification This section is applicable to all Federal-aid construction projects requested is not performed by a classification in the wage exceeding$2,000 and to all related subcontracts and lower-tier determination;and subcontracts(regardless of subcontract size). The requirements apply to all projects located within the right-of-way of a roadway (ii)The classification is utilized in the area by the that is functionally classified as Federal-aid highway. This construction industry;and excludes roadways functionally classified as local roads or rural minor collectors,which are exempt.Contracting agencies may (iii)The proposed wage rate,including any bona fide elect to apply these requirements to other projects. fringe benefits,bears a reasonable relationship to the wage rates contained in the wage determination. The following provisions are from the U.S.Department of Labor regulations in 29 CFR 5.5"Contract provisions and related (2)If the contractor and the laborers and mechanics to be matters"with minor revisions to conform to the FHWA- employed in the classification(if known),or their 1273 format and FHWA program requirements. representatives,and the contracting officer agree on the classification and wage rate(including the amount designated 1. Minimum wages for fringe benefits where appropriate),a report of the action taken shall be sent by the contracting officer to the a. All laborers and mechanics employed or working upon the Administrator of the Wage and Hour Division, Employment site of the work,will be paid unconditionally and not less often Standards Administration, U.S.Department of Labor, Washington,DC 20210.The Administrator,or an authorized than once a week,and without subsequent deduction or rebate on any account(except such payroll deductions as are permitted representative,will approve,modify,or disapprove every by regulations issued by the Secretary of Labor under the additional classification action within 30 days of receipt and so advise the contracting officer or will notify the contracting officer Copeland Act(29 CFR part 3)),the full amount of wages and bona fide fringe benefits(or cash equivalents thereof)due at time within the 30 day period that additional time is necessary. of payment computed at rates not less than those contained in the wage determination of the Secretary of Labor which is (3)In the event the contractor,the laborers or mechanics to attached hereto and made a part hereof,regardless of any be employed in the classification or their representatives,and contractual relationship which may be alleged to exist between the contracting officer do not agree on the proposed the contractor and such laborers and mechanics. classification and wage rate(including the amount designated for fringe benefits,where appropriate),the contracting officer Contributions made or costs reasonably anticipated for bona fide shall refer the questions, including the fringe benefits under section 1(b)(2)of the Davis-Bacon Act on views of all interested parties and the recommendation of the behalf of laborers or mechanics are considered wages paid to contracting officer,to the Waged and Hour Administrator or ar for such laborers or mechanics,subject to the provisions authorized ire The Wage and Hour ad a ermina i n an authorized representative,will issue a determination within 30 days of receipt and so advise the contracting officer or Spc09-43 C - 18 will notify the contracting officer within the 30-day period that Bacon Act,the contractor shall maintain records which show that additional time is necessary. the commitment to provide such benefits is enforceable,that the plan or program is financially responsible,and that the plan or (4) wage rate benefits program has been communicated in writing to the laborers or appropriate)Theetw)gete to(including pursuant fringeto beneparagfits where 1e.(2)or mechanics affected,and records which show the costs 1.b.(3)of this section,shall be paid to all workers performing anticipated or the actual cost incurred in providing such benefits. work in the classification under this contract from the first Contractors employing apprentices or trainees under approved day on which work is performed in the classification. programs shall maintain written evidence of the registration of apprenticeship programs and certification of trainee programs,the registration of the apprentices and trainees,and the ratios and c.Whenever the minimum wage rate prescribed in the contract wage rates prescribed in the applicable programs. for a class of laborers or mechanics includes a fringe benefit which is not expressed as an hourly rate,the contractor shall b.(1)The contractor shall submit weekly for each week in either pay the benefit as stated in the wage determination or shall which any contract work is performed a copy of all payrolls to the pay another bona fide fringe benefit or an hourly cash equivalent contracting agency. The payrolls submitted shall set out thereof. accurately and completely all of the information required to be maintained under 29 CFR 5.5(a)(3)(i),except that full social d. If the contractor does not make payments to a trustee or security numbers and home addresses shall not be included on other third person,the contractor may consider as part of the weekly transmittals. Instead the payrolls shall only need to wages of any laborer or mechanic the amount of any costs include an individually identifying number for each employee reasonably anticipated in providing bona fide fringe benefits e.g. ,the last four digits of the employee's social security under a plan or program,Provided,That the Secretary of Labor number).The required weekly payroll information may be has found,upon the written request of the contractor,that the submitted in any form desired.Optional Form WH-347 is applicable standards of the Davis-Bacon Act have been met. available for this purpose from the Wage and Hour Division Web The Secretary of Labor may require the contractor to set aside site at http://www.dol.gov/esa/whd/forms/wh347instr.htm or its in a separate account assets for the meeting of obligations successor site.The prime contractor is responsible for the under the plan or program. submission of copies of payrolls by all subcontractors. Contractors and subcontractors shall maintain the full social 2. Withholding security number and current address of each covered worker, and shall provide them upon request to the contracting agency for transmission to the State DOT,the FHWA or the Wage and Hour The contracting agency shall upon its own action or upon Division of the Department of Labor for purposes of an written request of an authorized representative of the investigation or audit of compliance with prevailing wage Department of Labor,withhold or cause to be withheld from requirements. It is not a violation of this section for a prime the contractor under this contract,or any other Federal contractor to require a subcontractor to provide addresses and contract with the same prime contractor,or any other federally- social security numbers to the prime contractor for its own assisted contract subject to Davis-Bacon prevailing wage records,without weekly submission to the contracting agency.. requirements,which is held by the same prime contractor,so much of the accrued payments or advances as may be (2)Each payroll submitted shall be accompanied by a"Statement considered necessary to pay laborers and mechanics, of Compliance,"signed by the contractor or subcontractor or his or including apprentices,trainees,and helpers,employed by the her agent who pays or supervises the payment of the persons contractor or any subcontractor the full amount of wages required employed under the contract and shall certify the following: by the contract. In the event of failure to pay any laborer or mechanic,including any apprentice,trainee,or helper,employed or working on the site of the work,all or part of the wages (i)That the payroll for the payroll period contains the required by the contract,the contracting agency may,after information required to be provided under§5.5(a)(3)(ii)of written notice to the contractor,take such action as may be Regulations,29 CFR part 5,the appropriate information is necessary to cause the suspension of any further payment, being maintained under§5.5(a)(3)(i)of Regulations,29 advance,or guarantee of funds until such violations have CFR part 5,and that such information is correct and ceased. complete; 3. Payrolls and basic records (ii)That each laborer or mechanic(including each helper, apprentice,and trainee)employed on the contract during the a. Payrolls and basic records relating thereto shall be payroll period has been paid the full weekly wages earned, maintained by the contractor during the course of the work and without rebate,either directly eitherr indirectly,directl and thatirno preserved for a period of three years thereafter for all laborers and deductions wagesve been made directly or indirectly from mechanics working at the site of the work.Such records shall the full earned,otherasthan contain the name,address,and social security number of each permissible deductions as set forth in Regulations,29 CFR such worker,his or her correct classification, hourly rates of part 3; wages paid(including rates of contributions or costs anticipated for bona fide fringe benefits or cash equivalents thereof of the (iii)That each laborer or mechanic has been paid not less types described in section 1(b)(2)(B)of the than the applicable wage rates and fringe benefits or cash Davis-Bacon Act),daily and weekly number of hours worked, equivalents for the classification of work performed,as deductions made and actual wages paid.Whenever the specified in the applicable wage determination incorporated Secretary of Labor has found under 29 CFR 5.5(a)(1)(iv)that the into the contract. wages of any laborer or mechanic include the amount of any costs reasonably anticipated in providing benefits under a plan or program described in section 1(b)(2)(B)of the Davis- Spc09-43 C - 19 (3)The weekly submission of a properly executed rate specified in the applicable wage determination. certification set forth on the reverse side of Optional Form Apprentices shall be paid fringe benefits in accordance with the WH-347 shall satisfy the requirement for submission of the provisions of the apprenticeship program. If the apprenticeship "Statement of Compliance"required by paragraph 3.b.(2)of program does not specify fringe benefits,apprentices must be this section. paid the full amount of fringe benefits listed on the wage determination for the applicable classification. If the (4)The falsification of any of the above certifications may Administrator determines that a different practice prevails for subject the contractor or subcontractor to civil or criminal the rda applicable with that dee rminaclassitiioation,fringes shall be paid in prosecution under section 1001 of title 18 and section 231 of accordance that determination. title 31 of the United States Code. In the event the Office of Apprenticeship Training, Employer and c.The contractor or subcontractor shall make the records Labor Services,or a State Apprenticeship Agency recognized by required under paragraph 3.a.of this section available for the Office,withdraws approval of an apprenticeship program,the inspection,copying,or transcription by authorized representatives contractor will no longer be permitted to utilize apprentices at less of the contracting agency,the State DOT,the FHWA, or the than the applicable predetermined rate for the work performed Department of Labor,and shall permit such representatives to until an acceptable program is approved. interview employees during working hours on the job. If the contractor or subcontractor fails to submit the required records or b.Trainees(programs of the USDOL). to make them available,the FI-WA may,after written notice to the contractor,the contracting agency or the State DOT,take Except as provided in 29 CFR 5.16,trainees will not be such action as may be necessary to cause the suspension of any permitted to work at less than the predetermined rate for the further payment,advance,or work performed unless they are employed pursuant to and guarantee of funds.Furthermore,failure to submit the required individually registered in a program which has received prior records upon request or to make such records available may be approval,evidenced by formal certification by the U.S. grounds for debarment action pursuant to 29 CFR 5.12. Department of Labor,Employment and Training Administration. 4. Apprentices and trainees The ratio of trainees to journeymen on the job site shall not be greater than permitted under the plan approved by the a.Apprentices(programs of the USDOL).Apprentices Employment and Training Administration. will be permitted to work at less than the Every trainee must be paid at not less than the rate specified in predetermined rate for the work they performed when they are the approved program for the trainee's level of progress, employed pursuant to and individually registered in a bona fide expressed as a percentage of the journeyman hourly rate apprenticeship program registered with the U.S.Department of specified in the applicable wage determination.Trainees shall be Labor, Employment and Training Administration,Office of paid fringe benefits in accordance with the provisions of the Apprenticeship Training,Employer and Labor Services,or with a trainee program.If the trainee program does not mention State Apprenticeship Agency recognized by the Office,or if a fringe benefits,trainees shall be paid the full amount of fringe person is employed in his or her first 90 days of probationary benefits listed on the wage determination unless the Administrator employment as an apprentice in such an apprenticeship program, of the Wage and Hour Division determines that there is an who is not individually registered in the program,but who has apprenticeship program associated with the corresponding been certified by the Office of Apprenticeship journeyman wage rate on the wage determination which provides Training,Employer and Labor Services or a State for less than full fringe benefits for apprentices.Any employee Apprenticeship Agency(where appropriate)to be eligible for listed on the payroll at a trainee rate who is not registered and probationary employment as an apprentice. participating in a training plan approved by the Employment and Training Administration shall be The allowable ratio of apprentices to journeymen on the job site paid not less than the applicable wage rate on the wage in any craft classification shall not be greater than the ratio determination for the classification of work actually performed. permitted to the contractor as to the entire work force under In addition,any trainee performing work on the job site in the registered program.Any worker listed on a payroll at an excess of the ratio permitted under the registered program thanthe apprentice wage rate,who is not registered or otherwise shall be paid not lessapplicablewage rate on the employed as stated above,shall be paid not less than the wage determination for theework actually performed. applicable wage rate on the wage determination for the classification of work actually performed. In addition,any In the event the Employment and Training Administration apprentice performing work on the job site in excess of the ratio withdraws approval of a training program,the contractor will no permitted under the registered program shall be paid not less longer be permitted to utilize trainees at less than the applicable than the applicable wage rate on the wage determination for the predetermined rate for the work performed until an acceptable 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 c. Equal employment opportunity.The utilization of percentages of the journeyman's hourly rate)specified in the apprentices,trainees and journeymen under this part shall be in contractor's or subcontractor's registered program shall be conformity with the equal employment opportunity requirements observed. 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, expressed as a percentage of the journeymen hourly Spc09-43 C -20 d. Apprentices and Trainees(programs of the U.S.DOT). Apprentices and trainees working under apprenticeship and skill S. CONTRACT WORK HOURS AND SAFETY STANDARDS ACT training programs which have been certified by the Secretary of Transportation as promoting EEO in connection with Federal-aid highway construction programs are not subject to the The following clauses apply to any Federal-aid construction requirements of paragraph 4 of this Section IV.The straight time contract in an amount in excess of$100,000 and subject to the hourly wage rates for apprentices and trainees under such overtime provisions of the Contract Work Hours and Safety programs will be established by the particular programs.The ratio Standards Act.These clauses shall be inserted in addition to the of apprentices and trainees to joumeymen shall not be greater clauses required by 29 CFR 5.5(a)or 29 CFR 4.6. As than permitted by the terms of the particular program. used in this paragraph,the terms laborers and mechanics include watchmen and guards. 5.Compliance with Copeland Act requirements. The contractor shall comply with the requirements of 29 CFR part 1.Overtime requirements. No contractor or subcontractor 3,which are incorporated by reference in this contract. contracting for any part of the contract work which may require or involve the employment of laborers or mechanics shall require or 6.Subcontracts. The contractor or subcontractor shall insert permit any such laborer or mechanic in any workweek in which Form FHWA-1273 in any subcontracts and also require the he or she is employed on such work to subcontractors to include Form FHWA-1273 in any lower tier work in excess aois e receiveses in such compensationwatatrate unless not lessh subcontracts.The prime contractor shall be responsible for the thn laborer or mechanic mese basic at a rate compliance by any subcontractor or lower tier subcontractor with workedan one and one-halfofforty hourso the surate kopay for all hours all the contract clauses in 29 CFR 5.5. in excess of in such workweek. 7. 2.Violation;liability for unpaid wages;liquidated damages. Contract termination:debarment. A breach of the contract In the event of any violation of the clause set forth in paragraph clauses in 29 CFR 5.5 may be grounds for termination of the contract,and for debarment as a contractor and a subcontractor (1.)of this section,the contractor and any subcontractor as provided in 29 CFR 5.12. responsible therefor shall be liable for the unpaid wages.In addition,such contractor and subcontractor shall be liable to the United States(in the case of work done 8.Compliance with Davis-Bacon and Related Act under contract for the District of Columbia or a territory,to such requirements. All rulings and interpretations of the Davis-Bacon District or to such territory),for liquidated damages.Such and Related Acts contained in 29 CFR parts 1,3,and 5 are liquidated damages shall be computed with respect to each herein incorporated by reference in this contract. individual laborer or mechanic, including watchmen and guards, employed in violation of the clause set forth in paragraph(1.)of 9.Disputes concerning labor standards.Disputes arising out of this section,in the sum of$10 for each calendar day on which the labor standards provisions of this contract shall not be subject such individual adworkweek was eek of fortyd or hourperms without twork in nt ofexcetheh of to the general disputes clause of this contract.Such disputes shall the standard esequieof clauses tforth payment of be resolved in accordance with the procedures overtime wages required by the set in paragraph of the Department of Labor set forth in 29 CFR parts 5,6,and (1•)of this section. 7. Disputes within the meaning of this clause include disputes between the contractor(or any of its subcontractors)and the 3.Withholding for unpaid wages and liquidated damages. contracting agency,the U.S.Department of Labor,or the The FHWA or the contacting agency shall upon its own action or employees or their representatives. upon written request of an authorized representative of the Department of Labor withhold or cause to be withheld,from any 10.Certification of eligibility. moneys payable on account of work performed by the contractor g ty, or subcontractor under any such contract or any other Federal contract with the same prime contractor,or any other federally- a. By entering into this contract,the contractor certifies that assisted contract subject to the Contract Work Hours and Safety neither it(nor he or she)nor any person or firm who has an Standards Act,which is held by the same prime contractor,such interest in the contractor's firm is a person or firm ineligible to be sums as may be determined to be necessary to satisfy any awarded Government contracts by virtue of section 3(a)of the liabilities of such contractor or subcontractor for unpaid wages Davis-Bacon Act or 29 CFR 5.12(a)(1). and liquidated damages as provided in the clause set forth in paragraph(2.)of this section. b. No part of this contract shall be subcontracted to any person or firm ineligible for award of a Govemment contract by virtue 4.Subcontracts. The contractor or subcontractor shall insert in of section 3(a)of the Davis-Bacon Act or 29 CFR 5.12(a)(1). any subcontracts the clauses set forth in paragraph(1.)through (4.)of this section and also a clause requiring the subcontractors to include these clauses in any lower tier subcontracts.The prime c.The penalty for making false statements is prescribed in the contractor shall be responsible for compliance by any U.S.Criminal Code, 18 U.S.C. 1001. subcontractor or lower tier subcontractor with the clauses set forth in paragraphs(1.)through(4.)of this section. Spc09-43 C -21 evidenced in writing and that it contains all pertinent provisions VI.SUBLETTING OR ASSIGNING THE CONTRACT and requirements of the prime contract. This provision is applicable to all Federal-aid construction 5.The 30%self-performance requirement of paragraph(1)is not contracts on the National Highway System. applicable to design-build contracts; however,contracting agencies may establish their own self-performance 1.The contractor shall perform with its own organization requirements. contract work amounting to not less than 30 percent(or a greater percentage if specified elsewhere in the contract)of the total original contract price,excluding any specialty items VII.SAFETY: ACCIDENT PREVENTION designated by the contracting agency. Specialty items may be performed by subcontract and the amount of any such T his pro v i s i o n is applicable to all Federal-aid specialty items performed may be deducted from the total construction contracts and to all related subcontracts. original contract price before computing the amount of work required to be performed by the contractors own organization 1. In the performance of this contract the contractor shall comply (23 CFR 635.116). with all applicable Federal, State,and local laws goveming safety,health,and sanitation(23 CFR 635).The contractor shall a. The term"perform work with its own organization"refers to provide all safeguards,safety devices and protective equipment workers employed or leased by the prime contractor,and and take any other needed actions as it determines,or as the equipment owned or rented by the prime contractor,with or contracting officer may determine,to be reasonably necessary to without operators. Such term does not include employees or protect the life and health of employees on the job and the safety equipment of a subcontractor or lower tier subcontractor,agents of the public and to protect property in connection with the of the prime contractor,or any other assignees. The term may performance of the work covered by the contract. include payments for the costs of hiring leased employees from an employee leasing firm meeting all relevant Federal and State 2. It is a condition of this contract,and shall be made a condition regulatory requirements. Leased employees may only be of each subcontract,which the contractor enters into pursuant to included in this term if the prime contractor meets all of the this contract,that the contractor and any subcontractor shall not following conditions: permit any employee,in performance of the contract,to work in surroundings or under conditions which are unsanitary, (1)the prime contractor maintains control over the hazardous or dangerous to his/her health or safety,as supervision of the day-to-day activities of the leased determined under construction safety and employees; health standards(29 CFR 1926)promulgated by the Secretary of (2)the prime contractor remains responsible for the quality of Labor,in accordance with Section 107 of the Contract Work Hours the work of the leased employees; and Safety Standards Act(40 U.S.C. 3704). (3)the prime contractor retains all power to accept or exclude individual employees from work on the project;and 3.Pursuant to 29 CFR 1926.3,it is a condition of this contract that (4)the prime contractor remains ultimately responsible for the Secretary of Labor or authorized representative thereof,shall the payment of predetermined minimum wages,the have right of entry to any site of contract performance to inspect submission of payrolls,statements of compliance and all or investigate the matter of compliance with the construction other Federal regulatory requirements. safety and health standards and to carry out the duties of the Secretary under Section 107 of the Contract Work Hours and b."Specialty Items"shall be construed to be limited to work Safety Standards Act(40 that requires highly specialized knowledge,abilities,or U.S.C.3704). equipment not ordinarily available in the type of contracting organizations qualified and expected to bid or propose on the contract as a whole and in general are to be limited to minor VIII.FALSE STATEMENTS CONCERNING HIGHWAY components of the overall contract. PROJECTS 2.The contract amount upon which the requirements set forth in T his pro v i s i o n is applicable to all Federal-aid paragraph(1)of Section VI is computed includes the cost of construction contracts and to all related subcontracts. material and manufactured products which are to be purchased or produced by the contractor under the contract In order to assure high quality and durable construction in provisions. conformity with approved plans and specifications and a high degree of reliability on statements and representations made by 3.The contractor shall furnish(a)a competent superintendent or engineers,contractors,suppliers,and workers on Federal-aid supervisor who is employed by the firm,has full authority to direct highway projects,it is essential that all persons concerned performance of the work in accordance with the contract with the project perform their functions as carefully,thoroughly, requirements,and is in charge of all construction operations and honestly as possible. Willful falsification,distortion,or (regardless of who performs the work)and(b)such other of its misrepresentation with respect to any facts related to the project is own organizational resources(supervision,management,and a violation of Federal law. To prevent any misunderstanding engineering services)as the contracting officer determines is regarding the seriousness of these and similar acts,Form FHWA- necessary to assure the performance of the contract. 1022 shall be posted on each Federal-aid highway project(23 CFR 635)in one or more 4.No portion of the contract shall be sublet,assigned or places where it is readily available to all persons concerned otherwise disposed of except with the written consent of the with the project: contracting officer,or authorized representative,and such consent when given shall not be construed to relieve the contractor of any responsibility for the fulfillment of the 18 U.S.C. 1020 reads as follows: contract. Written consent will be given only after the contracting agency has assured that each subcontract is Spc09-43 C -22 'Whoever,being an officer,agent,or employee of the United covered transaction.The prospective first tier participant shall States,or of any State or Territory,or whoever,whether a person, submit an explanation of why it cannot provide the certification set association,firm,or corporation,knowingly makes any false out below.The certification or explanation will be considered in statement,false representation,or false report as to the connection with the department or agency's determination character,quality,quantity,or cost of the material used or to whether to enter into this transaction.However,failure of the be used,or the quantity or quality of the work performed or to be prospective first tier participant to furnish a certification or an performed,or the cost thereof in connection with the submission explanation shall disqualify such a person from participation in of plans,maps,specifications,contracts,or costs this transaction. of construction on any highway or related project submitted for approval to the Secretary of Transportation;or c.The certification in this clause is a material representation of fact upon which reliance was placed when the contracting agency Whoever knowingly makes any false statement,false determined to enter into this transaction. If it is later determined representation,false report or false claim with respect to the that the prospective participant knowingly rendered an erroneous character,quality,quantity,or cost of any work performed or to be certification, in addition to other remedies available to the Federal performed,or materials furnished or to be furnished,in connection Government,the contracting agency may terminate this with the construction of any highway or related project approved transaction for cause of default. by the Secretary of Transportation;or d.The prospective first tier participant shall provide Whoever knowingly makes any false statement or false immediate written notice to the contracting agency to whom this representation as to material fact in any statement,certificate,or proposal is submitted if any time the prospective first tier report submitted pursuant to provisions of the Federal-aid Roads participant learns that its certification was erroneous when Act approved July 1, 1916,(39 Stat.355),as amended and submitted or has become erroneous by reason of changed supplemented; circumstances. Shall be fined under this title or imprisoned not more than 5 e.The terms"covered transaction,""debarred,""suspended," years or both." "ineligible,""participant,""person," "principal,"and"voluntarily excluded,"as used in this clause,are defined in 2 CFR Parts 180 and 1200. "First Tier Covered Transactions"refers to any IX.IMPLEMENTATION OF CLEAN AIR ACT AND FEDERAL covered transaction between a WATER POLLUTION CONTROL ACT grantee or subgrantee of Federal funds and a participant(such as the prime or general contract). "Lower Tier Covered Transactions" This provision is applicable to all Federal-aid construction refers to any covered transaction under a First Tier Covered contracts and to all related subcontracts. Transaction(such as subcontracts). "First Tier Participant"refers to the participant who has entered into a covered transaction with By submission of this bid/proposal or the execution of this a grantee or subgrantee of Federal funds(such as the prime or contract,or subcontract,as appropriate,the bidder,proposer, general contractor). "Lower Tier Participant"refers any participant Federal-aid construction contractor,or subcontractor,as who has entered into a covered transaction with a First Tier appropriate,will be deemed to have stipulated as follows: Participant or other Lower Tier Participants(such as subcontractors and suppliers). 1.That any person who is or will be utilized in the performance of this contract is not prohibited from receiving an award due to a f.The prospective first tier participant agrees by submitting this violation of Section 508 of the Clean Water Act or Section 306 of proposal that,should the proposed covered transaction be the Clean Air Act. entered into,it shall not knowingly enter into any lower tier 2.That the contractor agrees to include or cause to be included covered transaction with a person who is debarred, the requirements of paragraph(1)of this Section X in every suspended,declared ineligible,or voluntarily excluded from subcontract,and further agrees to take such action as participation in this covered transaction,unless authorized by the contracting agency may direct as a means of enforcing the department or agency entering into this transaction. such requirements. g.The prospective first tier participant further agrees by submitting this proposal that it will include the clause titled X.CERTIFICATION REGARDING DEBARMENT, "Certification Regarding Debarment,Suspension, Ineligibility and SUSPENSION,INELIGIBILITY AND VOLUNTARY Voluntary Exclusion-Lower Tier Covered Transactions,"provided EXCLUSION by the department or contracting agency,entering into this covered transaction,without modification,in all lower tier This provision is applicable to all Federal-aid construction covered transactions and in all solicitations for lower tier covered contracts,design-build contracts,subcontracts, lower-tier transactions exceeding the$25,000 threshold. subcontracts,purchase orders,lease agreements,consultant contracts or any other covered transaction requiring FHWA h.A participant in a covered transaction may rely upon a approval or that is estimated to cost$25,000 or more— as certification of a prospective participant in a lower tier covered defined in 2 CFR Parts 180 and 1200. transaction that is not debarred,suspended, ineligible,or 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 1.Instructions for Certification—First Tier Participants: otherwise ineligible to participate in covered transactions. To verify the eligibility of its principals,as well as the eligibility of any a. By signing and submitting this proposal,the prospective lower tier prospective participants,each participant may,but is not first tier participant is providing the certification set out below. required to,check the Excluded Parties List System website (https://www.epls.00v/),which is compiled by the General b.The inability of a person to provide the certification set out Services Administration. below will not necessarily result in denial of participation in this Spc09-43 C - 23 i. Nothing contained in the foregoing shall be construed to this transaction originated may pursue available remedies, require the establishment of a system of records in order to including suspension and/or debarment. render in good faith the certification required by this clause.The knowledge and information of the prospective participant is not c.The prospective lower tier participant shall provide immediate required to exceed that which is normally possessed by a written notice to the person to which this proposal is submitted if at prudent person in the ordinary course of business dealings. any time the prospective lower tier participant learns that its certification was erroneous by reason of j.Except for transactions authorized under paragraph(f)of changed circumstances. these instructions,if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a d.The terms"covered transaction,""debarred,""suspended," person who is suspended,debarred,ineligible,or voluntarily "ineligible,""participant,""person,""principal,"and"voluntarily excluded from participation in this transaction, in addition to other excluded,"as used in this clause,are defined in 2 CFR Parts 180 remedies available to the Federal Government,the department or and 1200. You may contact the person to which this proposal is agency may terminate this transaction for cause or default. 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 and a participant(such as the 2. Certification Regarding Debarment,Suspension, prime or general contract). "Lower Tier Covered Transactions" Ineligibility and Voluntary Exclusion—First Tier refers to any covered transaction under a First Tier Covered Participants: Transaction(such as subcontracts). "First Tier Participant" refers to the participant who has entered into a covered a. The prospective first tier participant certifies to the best of its transaction with a grantee or subgrantee of Federal funds(such knowledge and belief,that it and its principals: as the prime or general contractor). "Lower Tier Participant" refers any participant who has entered into a covered transaction (1) Are not presently debarred,suspended,proposed for with a First Tier Participant or other Lower Tier Participants(such debarment,declared ineligible,or voluntarily excluded from as subcontractors and suppliers). participating in covered transactions by any Federal department or agency; e.The prospective lower tier participant agrees by submitting this proposal that,should the proposed covered transaction be (2) Have not within a three-year period preceding this entered into,it shall not knowingly enter into any lower tier proposal been convicted of or had a civil judgment rendered covered transaction with a person who is debarred,suspended, against them for commission of fraud or a criminal offense in declared ineligible,or voluntarily excluded from participation in connection with obtaining,attempting to obtain,or performing a this covered transaction,unless authorized by the department or public(Federal,State or local)transaction or contract under a agency with which this transaction originated. public transaction;violation of Federal or State antitrust statutes or commission of embezzlement,theft,forgery,bribery, f.The prospective lower tier participant further agrees by falsification or destruction of records,making false statements, submitting this proposal that it will include this clause titled or receiving stolen property; "Certification Regarding Debarment,Suspension,Ineligibility and Voluntary Exclusion-Lower Tier Covered Transaction,"without (3) Are not presently indicted for or otherwise criminally or modification,in all lower tier covered transactions and in all civilly charged by a govemmental entity(Federal,State or local) solicitations for lower tier covered transactions exceeding the with commission of any of the offenses enumerated in paragraph $25,000 threshold. (a)(2)of this certification;and g.A participant in a covered transaction may rely upon a (4) Have not within a three-year period preceding this certification of a prospective participant in a lower tier covered application/proposal had one or more public transactions transaction that is not debarred,suspended,ineligible,or (Federal,State or local)terminated for cause or default. voluntarily excluded from the covered transaction,unless it knows that the certification is erroneous.A participant is responsible for b. Where the prospective participant is unable to certify to ensuring that its principals are not suspended,debarred,or any of the statements in this certification,such prospective otherwise ineligible to participate in covered transactions. To participant shall attach an explanation to this proposal. verify the eligibility of its principals,as well as the eligibility of any lower tier prospective participants,each participant may,but is not 2.Instructions for Certification-Lower Tier Participants: required to,check the Excluded Parties List System website (https://www.eols.gov/),which is compiled by the General (Applicable to all subcontracts,purchase orders and other Services Administration. lower tier transactions requiring prior FHWA approval or estimated to cost$25,000 or more-2 CFR Parts 180 and h. Nothing contained in the foregoing shall be construed to 1200) require establishment of a system of records in order to render in good faith the certification required by this clause.The knowledge a. By signing and submitting this proposal,the prospective and information of participant is not required to exceed that which lower tier is providing the certification set out below. is normally possessed by a prudent person in the ordinary course of business dealings. b.The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was i.Except for transactions authorized under paragraph e of entered into.If it is later determined that the prospective lower tier these instructions,if a participant in a covered transaction participant knowingly rendered an erroneous certification,in knowingly enters into a lower tier covered transaction with a addition to other remedies available to the Federal Government, person who is suspended,debarred, ineligible,or voluntarily the department,or agency with which excluded from participation in this transaction,in addition to other remedies available to the Federal Government,the Spc09-43 C - 24 department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion--Lower Tier Participants: 1.The prospective lower tier participant certifies,by submission of this proposal,that neither it nor its principals is presently debarred, suspended,proposed for debarment,declared ineligible,or voluntarily excluded from participating in covered transactions by any Federal department or agency. 2.Where the prospective lower tier participant is unable to certify to any of the statements in this certification,such prospective participant shall attach an explanation to this proposal. XI.CERTIFICATION REGARDING USE OF CONTRACT FUNDS FOR LOBBYING This provision is applicable to all Federal-aid construction contracts and to all related subcontracts which exceed $100,000(49 CFR 20). 1.The prospective participant certifies,by signing and submitting this bid or proposal,to the best of his or her knowledge and belief,that: a. 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. b. 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 Form to Report Lobbying,"in accordance with its instructions. 2.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 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 $100,000 and that all such recipients shall certify and disclose accordingly. Spc09-43 C -25 ATTACHMENT A-EMPLOYMENT AND MATERIALS 6. The contractor shall include the provisions of Sections 1 PREFERENCE FOR APPALACHIAN DEVELOPMENT through 4 of this Attachment A in every subcontract for work which HIGHWAY SYSTEM OR APPALACHIAN LOCAL ACCESS is,or reasonably may be,done as on-site work. ROAD CONTRACTS This provision is applicable to all Federal-aid projects funded under the Appalachian Regional Development Act of 1965. 1.During the performance of this contract,the contractor undertaking to do work which is,or reasonably may be,done as on-site work,shall give preference to qualified persons who regularly reside in the labor area as designated by the DOL wherein the contract work is situated,or the subregion,or the Appalachian counties of the State wherein the contract work is situated,except: a.To the extent that qualified persons regularly residing in the area are not available. b.For the reasonable needs of the contractor to employ supervisory or specially experienced personnel necessary to assure an efficient execution of the contract work. c.For the obligation of the contractor to offer employment to present or former employees as the result of a lawful collective bargaining contract,provided that the number of nonresident persons employed under this subparagraph(1 c)shall not exceed 20 percent of the total number of employees employed by the contractor on the contract work,except as provided in subparagraph(4)below. 2.The contractor shall place a job order with the State Employment Service indicating(a)the classifications of the laborers,mechanics and other employees required to perform the contract work,(b)the number of employees required in each classification,(c)the date on which the participant estimates such employees will be required,and(d)any other pertinent information required by the State Employment Service to complete the job order form. The job order may be placed with the State Employment Service in writing or by telephone. If during the course of the contract work,the information submitted by the contractor in the original job order is substantially modified,the participant shall promptly notify the State Employment Service. 3.The contractor shall give full consideration to all qualified job applicants referred to him by the State Employment Service. The contractor is not required to grant employment to any job applicants who, in his opinion,are not qualified to perform the classification of work required. 4. If,within one week following the placing of a job order by the contractor with the State Employment Service,the State Employment Service is unable to refer any qualified job applicants to the contractor,or less than the number requested, the State Employment Service will forward a certificate to the contractor indicating the unavailability of applicants. Such certificate shall be made a part of the contractor's permanent project records. Upon receipt of this certificate,the contractor may employ persons who do not normally reside in the labor area to fill positions covered by the certificate, notwithstanding the provisions of subparagraph (1c) above. 5. The provisions of 23 CFR 633.207(e)allow the contracting agency to provide a contractual preference for the use of mineral resource materials native to the Appalachian region. Spc09-43 C -26 NOTICE TO BIDDERS FEDERAL REQUIREMENTS Proposal Phase If you are the apparent low bidder, second low bidder, or third low bidder, you must submit the following form, either with your bid or within four (4) business days after bid opening: ❑ Local Agency Bidder DBE Commitment (Construction Contracts), Exhibit 15-G (p. F-30) In addition, you are strongly encouraged, and may be required, to submit the following form as a supplement to Exhibit 15-G: ❑ DBE Information — Good Faith Efforts, Exhibit 15-H (p. F-32) To assist the City in updating its Bidders List, all bidders are requested to submit the following form with their bids: ❑ Bidder Information Sheet(s) (p. F-41) Upon execution and submission of your bid, you are agreeing to be bound by the following (but do not need to return the forms): • Equal Employment Opportunity Certification (p. F-25) • Debarment and Suspension Certification (p. F-26) • Nonlobbying Certification for Federal-Aid Contracts (p. F-27) If applicable, the following form must be submitted with the bid: ❑ Disclosure of Lobbying Activities (p. F-28) Construction Phase If applicable, you will be required to submit the following form each month during construction: ❑ Monthly DBE Trucking Verification (p. F-35) Post-Construction Phase When construction is completed, you will be required to submit the following forms to the City: ❑ Final Report— Utilization of Disadvantaged Businesses (p. F-37) ❑ Disadvantaged Business Enterprises (DBE) Certification Status Change (p. F-39) Spc09-43 F- 1 Local Assistance Procedures Manual Exhibit 12-G Required Federal-aid Contract Language EXHIBIT 12-G REQUIRED FEDERAL-AID CONTRACT LANGUAGE (For Local Assistance Construction Projects) The following language must be incorporated into all Local Assistance Federal-aid construction contracts. The following language,with minor edits,was taken from the 2010 Caltrans Standard Specifications,Revised Standard Specifications issued by Caltrans Office Engineer, and the Code of Federal Regulations. Table of Contents Section Page No. 1. DISADVANTAGED BUSINESS ENTERPRISES(DBE) 3 DBE COMMITMENT SUBMITTAL 3 GOOD FAITH EFFORTS SUBMITTAL 4 EXHIBIT 15-G LOCAL AGENCY BIDDER DBE INFORMATION(CONSTRUCTION CONTRACTS) 4 SUBCONTRACTOR AND DISADVANTAGED BUSINESS ENTERPRISE RECORDS 5 PERFORMANCE OF DISADVANTAGED BUSINESS ENTERPRISES 5 2. BID OPENING 6 3. BID RIGGING 6 4. CONTRACT AWARD 6 5. CONTRACTOR LICENSE 6 6. DIFFERING SITE CONDITIONS 6 CONTRACTOR'S NOTIFICATION 6 ENGINEER'S INVESTIGATION AND DECISION 7 7. BEGINNING OF WORK,TIME OF COMPLETION AND LIQUIDATED DAMAGES 7 8. BUY AMERICA 7 9. QUALITY ASSURANCE 7 10. PROMPT PAYMENT OF FUNDS WITHHELD TO SUBCONTRACTORS 7 11. FORM FHWA-1273 REQUIRED CONTRACT PROVISIONS FEDERAL-AID CONTRACTS 8 12. FEMALE AND MINORITY GOALS 20 13. FEDERAL TRAINEE PROGRAM 21 14.TITLE VI ASSURANCES 22 Spc09-43 F-2 Local Assistance Procedures Manual Exhibit 12-G Required Federal-aid Contract Language 1. DISADVANTAGED BUSINESS ENTERPRISES(DBE) Under 49 CFR 26.13(b): The contractor, subrecipient or subcontractor shall not discriminate on the basis of race,color, national origin, or sex in the performance of this contract. The contractor shall carry out applicable requirements of 49 CFR part 26 in the award and administration of DOT-assisted contracts. Failure by the contractor to carry out these requirements is a material breach of this contract, which may result in the termination of this contract or such other remedy as the recipient deems appropriate. Take necessary and reasonable steps to ensure that DBEs have opportunity to participate in the contract(49 CFR 26). To ensure equal participation of DBEs provided in 49 CFR 26.5,the Agency shows a goal for DBEs. Make work available to DBEs and select work parts consistent with available DBE subcontractors and suppliers. Meet the DBE goal shown elsewhere in these special provisions or demonstrate that you made adequate good faith efforts to meet this goal. It is your responsibility to verify that the DBE firm is certified as DBE at date of bid opening. For a list of DBEs certified by the California Unified Certification Program,go to: http://www.dot.ca.gov/hq/bep/find_certified.htm. All DBE participation will count toward the California Department of Transportation's federally mandated statewide overall DBE goal. Credit for materials or supplies you purchase from DBEs counts towards the goal in the following manner: • 100 percent counts if the materials or supplies are obtained from a DBE manufacturer. • 60 percent counts if the materials or supplies are obtained from a DBE regular dealer. • Only fees,commissions, and charges for assistance in the procurement and delivery of materials or supplies count if obtained from a DBE that is neither a manufacturer nor regular dealer. 49 CFR 26.55 defines "manufacturer" and"regular dealer." You receive credit towards the goal if you employ a DBE trucking company that performs a commercially useful function as defined in 49 CFR 26.55(d)(1)through(4)and(6). a. DBE Commitment Submittal Submit the Exhibit 15-G Local Agency Bidder DBE Commitment(Construction Contracts) form, included in the Bid book. If the form is not submitted with the bid,remove the form from the Bid book before submitting your bid. If the DBE Commitment form is not submitted with the bid,the apparent low bidder,the 2nd low bidder, and the 3rd low bidder must complete and submit the DBE Commitment form to the Agency. DBE Commitment form must be received by the Agency no later than 4:00 p.m. on the 4th business day after bid opening. Other bidders do not need to submit the DBE Commitment form unless the Agency requests it. If the Agency requests you to submit a DBE Commitment form, submit the completed form within 4 business days of the request. Submit written confirmation from each DBE stating that it is participating in the contract. Include confirmation with the DBE Commitment form. A copy of a DBE's quote will serve as written confirmation that the DBE is participating in the contract. If you do not submit the DBE Commitment form within the specified time,the Agency will find your bid nonresponsive. Spc09-43 F-3 Local Assistance Procedures Manual Exhibit 12-G Required Federal-aid Contract Language b. Good Faith Efforts Submittal If you have not met the DBE goal,complete and submit the DBE Information-Good Faith Efforts, Exhibit 15-H, form with the bid showing that you made adequate good faith efforts to meet the goal. Only good faith efforts directed towards obtaining participation by DBEs will be considered. If good faith efforts documentation is not submitted with the bid, it must be received by the Agency no later than 4:00 p.m. on the 4th business day after bid opening. If your DBE Commitment form shows that you have met the DBE goal or if you are required to submit the DBE Commitment form,you must also submit good faith efforts documentation within the specified time to protect your eligibility for award of the contract in the event the Agency finds that the DBE goal has not been met. Good faith efforts documentation must include the following information and supporting documents, as necessary: 1. Items of work you have made available to DBE firms. Identify those items of work you might otherwise perform with your own forces and those items that have been broken down into economically feasible units to facilitate DBE participation. For each item listed, show the dollar value and percentage of the total contract. It is your responsibility to demonstrate that sufficient work to meet the goal was made available to DBE firms. 2. Names of certified DBEs and dates on which they were solicited to bid on the project. Include the items of work offered. Describe the methods used for following up initial solicitations to determine with certainty if the DBEs were interested, and the dates of the follow-up. Attach supporting documents such as copies of letters,memos, facsimiles sent, telephone logs,telephone billing statements, and other evidence of solicitation. You are reminded to solicit certified DBEs through all reasonable and available means and provide sufficient time to allow DBEs to respond. 3. Name of selected firm and its status as a DBE for each item of work made available. Include name,address, and telephone number of each DBE that provided a quote and their price quote. If the firm selected for the item is not a DBE,provide the reasons for the selection. 4. Name and date of each publication in which you requested DBE participation for the project. Attach copies of the published advertisements. 5. Names of agencies and dates on which they were contacted to provide assistance in contacting,recruiting, and using DBE firms. If the agencies were contacted in writing, provide copies of supporting documents. 6. List of efforts made to provide interested DBEs with adequate information about the plans, specifications, and requirements of the contract to assist them in responding to a solicitation. If you have provided information, identify the name of the DBE assisted,the nature of the information provided,and date of contact. Provide copies of supporting documents,as appropriate. 7. List of efforts made to assist interested DBEs in obtaining bonding, lines of credit,insurance, necessary equipment, supplies,and materials,excluding supplies and equipment that the DBE subcontractor purchases or leases from the prime contractor or its affiliate. If such assistance is provided by you, identify the name of the DBE assisted,nature of the assistance offered, and date assistance was provided. Provide copies of supporting documents,as appropriate. 8. Any additional data to support demonstration of good faith efforts. The Agency may consider DBE commitments of the 2nd and 3rd bidders when determining whether the low bidder made good faith efforts to meet the DBE goal. c. Exhibit 15-G-Local Agency Bidder DBE Information (Construction Contracts) Complete and sign Exhibit 15-G Local Agency Bidder DBE Commitment(Construction Contracts) included in the contract documents regardless of whether DBE participation is reported. Spc09-43 F-4 Local Assistance Procedures Manual Exhibit 12-G Required Federal-aid Contract Language Provide written confirmation from each DBE that the DBE is participating in the Contract. A copy of a DBE's quote serves as written confirmation. If a DBE is participating as a joint venture partner,the Agency encourages you to submit a copy of the joint venture agreement.) d Subcontractor and Disadvantaged Business Enterprise Records Use each DBE subcontractor as listed on Exhibit 12-B Bidder's List of Subcontractors (DBE and Non-DBE) and Exhibit 15-G Local Agency Bidder DBE Commitment(Construction Contracts) form unless you receive authorization for a substitution. The Agency requests the Contractor to: 1. Notify the Engineer of any changes to its anticipated DBE participation 2. Provide this notification before starting the affected work 3. Maintain records including: • Name and business address of each 1"-tier subcontractor • Name and business address of each DBE subcontractor, DBE vendor, and DBE trucking company,regardless of tier • Date of payment and total amount paid to each business If you are a DBE contractor, include the date of work performed by your own forces and the corresponding value of the work. Before the 15th of each month, submit a Monthly DBE Trucking Verification form. If a DBE is decertified before completing its work,the DBE must notify you in writing of the decertification date. If a business becomes a certified DBE before completing its work,the business must notify you in writing of the certification date. Submit the notifications. On work completion,complete a Disadvantaged Business Enterprises(DBE) Certification Status Change, Exhibit 17-0, form. Submit the form within 30 days of contract acceptance. Upon work completion, complete Exhibit 17-F Final Report— Utilization of Disadvantaged Business Enterprises (DBE), First-Tier Subcontractors. Submit it within 90 days of contract acceptance. The Agency will withhold$10,000 until the form is submitted. The Agency releases the withhold upon submission of the completed form. e. Performance of Disadvantaged Business Enterprises DBEs must perform work or supply materials as listed in the Exhibit 15-G Local Agency Bidder DBE Commitment(Construction Contracts) form, included in the Bid. Do not terminate or substitute a listed DBE for convenience and perform the work with your own forces or obtain materials from other sources without authorization from the Agency. The Agency authorizes a request to use other forces or sources of materials if it shows any of the following justifications: 1. Listed DBE fails or refuses to execute a written contract based on plans and specifications for the project. 2. You stipulated that a bond is a condition of executing the subcontract and the listed DBE fails to meet your bond requirements. 3. Work requires a contractor's license and listed DBE does not have a valid license under Contractors License Law. 4. Listed DBE fails or refuses to perform the work or furnish the listed materials. 5. Listed DBE's work is unsatisfactory and not in compliance with the contract. 6. Listed DBE is ineligible to work on the project because of suspension or debarment. 7. Listed DBE becomes bankrupt or insolvent. Spc09-43 F-5 Local Assistance Procedures Manual Exhibit 12-G Required Federal-aid Contract Language 8. Listed DBE voluntarily withdraws with written notice from the Contract 9. Listed DBE is ineligible to receive credit for the type of work required. 10. Listed DBE owner dies or becomes disabled resulting in the inability to perform the work on the Contract. 11. Agency determines other documented good cause. Notify the original DBE of your intent to use other forces or material sources and provide the reasons. Provide the DBE with 5 days to respond to your notice and advise you and the Agency of the reasons why the use of other forces or sources of materials should not occur. Your request to use other forces or material sources must include: 1. One or more of the reasons listed in the preceding paragraph 2. Notices from you to the DBE regarding the request 3. Notices from the DBEs to you regarding the request If a listed DBE is terminated or substituted,you must make good faith efforts to find another DBE to substitute for the original DBE. The substitute DBE must perform at least the same amount of work as the original DBE under the contract to the extent needed to meet the DBE goal. The substitute DBE must be certified as a DBE at the time of request for substitution. Unless the Agency authorizes(1) a request to use other forces or sources of materials or(2) a good faith effort for a substitution of a terminated DBE,the Agency does not pay for work listed on the Exhibit 15-G Local Agency Bidder DBE Commitment(Construction Contracts) form unless it is performed or supplied by the listed DBE or an authorized substitute. 2. BID OPENING The Agency publicly opens and reads bids at the time and place shown on the Notice to Bidders. 3. BID RIGGING The U.S. Department of Transportation(DOT)provides a toll-free hotline to report bid rigging activities. Use the hotline to report bid rigging,bidder collusion, and other fraudulent activities. The hotline number is (800)424-9071. The service is available 24 hours 7 days a week and is confidential and anonymous.. The hotline is part of the DOT's effort to identify and investigate highway construction contract fraud and abuse and is operated under the direction of the DOT Inspector General. 4. CONTRACT AWARD If the Agency awards the contract,the award is made to the lowest responsible bidder. 5. CONTRACTOR LICENSE The Contractor must be properly licensed as a contractor from contract award through Contract acceptance (Public Contract Code § 10164). 6. DIFFERING SITE CONDITIONS a. Contractor's Notification Promptly notify the Agency's Engineer if you find either of the following conditions: 1. Physical conditions differing materially from either of the following: • Contract documents • Job site examination 2. Physical conditions of an unusual nature, differing materially from those ordinarily encountered and generally recognized as inherent in the work provided for in the Contract Include details explaining the information you relied on and the material differences you discovered. Spc09-43 F-6 Local Assistance Procedures Manual Exhibit 12-G Required Federal-aid Contract Language If you fail to promptly notify the Engineer,you waive the differing site condition claim for the period between your discovery of the differing site condition and your notification to the Engineer. If you disturb the site after discovery and before the Engineer's investigation,you waive the differing site condition claim. b. Engineer's Investigation and Decision Upon your notification,the Engineer investigates job site conditions and: 1. Notifies you whether to resume affected work 2. Decides whether the condition differs materially and is cause for an adjustment of time, payment, or both 7. BEGINNING OF WORK, TIME OF COMPLETION AND LIQUIDATED DAMAGES The Contractor shall begin work within 15 calendar days after the contract has been approved by the attorney appointed and authorized to represent the City of Rancho Palos Verdes. This work shall be diligently prosecuted to completion before the expiration of 80 WORKING DAYS from the effective date of the Notice to Proceed. The Contractor shall pay to the City of Rancho Palos Verdes the sum of$800 per day, for each and every calendar day's delay in finishing the work in excess of the number of working days prescribed above. 8. BUY AMERICA Furnish steel and iron materials to be incorporated into the work with certificates of compliance. Steel and iron materials must be produced in the U.S. except: 1. Foreign pig iron and processed,pelletized,and reduced iron ore may be used in the domestic production of the steel and iron materials [60 Fed Reg 15478 (03/24/1995)]; 2. If the total combined cost of the materials does not exceed the greater of 0.1 percent of the total bid or$2,500,materials produced outside the U.S. may be used. Production includes: 1. Processing steel and iron materials, including smelting or other processes that alter the physical form or shape(such as rolling, extruding,machining,bending, grinding, and drilling)or chemical composition; 2. Coating application, including epoxy coating,galvanizing, and painting, that protects or enhances the value of steel and iron materials. 9. QUALITY ASSURANCE The Agency uses a Quality Assurance Program(QAP)to ensure a material is produced to comply with the Contract. You may examine the records and reports of tests the Agency performs if they are available at the job site. Schedule work to allow time for QAP. 10. PROMPT PAYMENT OF FUNDS WITHHELD TO SUBCONTRACTORS (The local agency must include one of the following three provisions to ensure prompt and full payment of any retainage from the prime contractor, or subcontractor,to a subcontractor. Remove or strike out the methods not used.) (EITHER) Spc09-43 F-7 Local Assistance Procedures Manual Exhibit 12-G Required Federal-aid Contract Language •-- • - --- - (OR) - • - - ! - •- - • , . . -- - •--- ! - - ' -- -- • - --- (OR) The agency shall hold retainage from the prime contractor and shall make prompt and regular incremental acceptances of portions,as determined by the agency,of the contract work, and pay retainage to the prime contractor based on these acceptances. The prime contractor,or subcontractor, shall return all monies withheld in retention from a subcontractor within 30 days after receiving payment for work satisfactorily completed and accepted including incremental acceptances of portions of the contract work by the agency. Federal law(49CFR26.29)requires that any delay or postponement of payment over 30 days may take place only for good cause and with the agency's prior written approval. Any violation of this provision shall subject the violating prime contractor or subcontractor to the penalties, sanctions and other remedies specified in Section 7108.5 of the Business and Professions Code. These requirements shall not be construed to limit or impair any contractual,administrative,or judicial remedies otherwise available to the prime contractor or subcontractor in the event of a dispute involving late payment or nonpayment by the prime contractor, deficient subcontract performance, or noncompliance by a subcontractor. 11. FORM FHWA-1273 REQUIRED CONTRACT PROVISIONS FEDERAL AID CONTRACTS (Excluding ATTACHMENT A -EMPLOYMENT AND MATERIALS PREFERENCE FOR APPALACHIAN DEVELOPMENT HIGHWAY SYSTEM OR APPALACHIAN LOCAL ACCESS ROAD CONTRACTS) [The following 10 pages must be physically inserted into the contract without modification.] Spc09-43 F-8 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 I. General II. NONDISCRIMINATION II. Nondiscrimination III. Nonsegregated 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 are VI. Subletting or Assigning the Contract not applicable to material supply,engineering,or architectural service VII. Safety:Accident Prevention contracts. VIII. False Statements Concerning Highway Projects IX. Implementation of Clean Air Act and Federal Water Pollution In addition,the contractor and all subcontractors must comply with the Control Act following policies:Executive Order 11246,41 CFR 60,29 CFR 1625- X. Compliance with Govemmentwide Suspension and Debarment 1627,Title 23 USC Section 140,the Rehabilitation Act of 1973,as Requirements amended(29 USC 794),Title VI of the Civil Rights Act of 1964,as XI. Certification Regarding Use of Contract Funds for Lobbying amended,and related regulations including 49 CFR Parts 21,26 and 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(included for all construction contracts exceeding$10,000,the Standard Federal in Appalachian contracts only) Equal Employment Opportunity Construction Contract Specifications in 41 CFR 60-4.3. I. GENERAL Note:The U.S.Department of Labor has exclusive authority to determine compliance with Executive Order 11246 and the policies of the Secretary 1. Form FHWA-1273 must be physically incorporated in each of Labor including 41 CFR 60,and 29 CFR 1625-1627. The contracting construction contract funded under Title 23(excluding emergency agency and the FHWA have the authority and the responsibility to contracts solely intended for debris removal). The contractor(or ensure compliance with Title 23 USC Section 140,the Rehabilitation Act subcontractor)must insert this form in each subcontract and further of 1973,as amended(29 USC 794),and Title VI of the Civil Rights Act of require its inclusion in all lower tier subcontracts(excluding purchase 1964,as amended,and related regulations including 49 CFR Parts 21, orders,rental agreements and other agreements for supplies or 26 and 27;and 23 CFR Parts 200,230,and 633. services). The following provision is adopted from 23 CFR 230,Appendix A,with The applicable requirements of Form FHWA-1273 are incorporated by appropriate revisions to conform to the U.S.Department of Labor(US reference for work done under any purchase order,rental agreement or DOL)and FHWA requirements. agreement for other services. The prime contractor shall be responsible for compliance by any subcontractor,lower-tier subcontractor or service 1.Equal Employment Opportunity:Equal employment opportunity provider. (EEO)requirements not to discriminate and to take affirmative action to assure equal opportunity as set forth under laws,executive orders,rules, Form FHWA-1273 must be included in all Federal-aid design-build regulations(28 CFR 35,29 CFR 1630,29 CFR 1625-1627,41 CFR 60 contracts,in all subcontracts and in lower tier subcontracts(excluding and 49 CFR 27)and orders of the Secretary of Labor as modified by the subcontracts for design services,purchase orders,rental agreements provisions prescribed herein,and imposed pursuant to 23 U.S.C.140 and other agreements for supplies or services). The design-builder shall shall constitute the EEO and specific affirmative action standards for the be responsible for compliance by any subcontractor,lower-tier contractor's project activities under this contract.The provisions of the subcontractor or service provider. Americans with Disabilities Act of 1990(42 U.S.C.12101 et seq.)set forth under 28 CFR 35 and 29 CFR 1630 are incorporated by reference Contracting agencies may reference Form FHWA-1273 in bid proposal in this contract.In the execution of this contract,the contractor agrees to or request for proposal documents,however,the Form FHWA-1273 must comply with the following minimum specific requirement activities of be physically incorporated(not referenced)in all contracts,subcontracts EEO: and lower-tier subcontracts(excluding purchase orders,rental agreements and other agreements for supplies or services related to a a.The contractor will work with the contracting agency and the Federal construction contract). Government to ensure that it has made every good faith effort to provide equal opportunity with respect to all of its terms and conditions of 2. Subject to the applicability criteria noted in the following sections, employment and in their review of activities under the contract. these contract provisions shall apply to all work performed on the contract by the contractor's own organization and with the assistance of b.The contractor will accept as its operating policy the following workers under the contractor's immediate superintendence and to all statement: work performed on the contract by piecework,station work,or by subcontract. "It is the policy of this Company to assure that applicants are employed,and that employees are treated during employment,without 3. A breach of any of the stipulations contained in these Required regard to their race,religion,sex,color,national origin,age or Contract Provisions may be sufficient grounds for withholding of progress disability. Such action shall include:employment,upgrading, payments,withholding of final payment,termination of the contract, demotion,or transfer;recruitment or recruitment advertising;layoff or suspension/debarment or any other action determined to be appropriate termination;rates of pay or other forms of compensation;and selection by the contracting agency and FHWA. for training,including apprenticeship,pre-apprenticeship,and/or on- the-job training." 4. Selection of Labor:During the performance of this contract,the contractor shall not use convict labor for any purpose within the limits of 2. EEO Officer:The contractor will designate and make known to the a construction project on a Federal-aid highway unless it is labor contracting officers an EEO Officer who will have the responsibility for performed by convicts who are on parole,supervised release,or and must be capable of effectively administering and promoting an probation. The term Federal-aid highway does not include roadways active EEO program and who must be assigned adequate authority and functionally classified as local roads or rural minor collectors. responsibility to do so Spc09-43 F-9 Local Assistance Procedures Manual Exhibit 12-G Required Federal-aid Contract Language 3. Dissemination of Policy:All members of the contractor's staff b. The contractor will periodically evaluate the spread of wages who are authorized to hire,supervise,promote,and discharge paid within each classification to determine any evidence of employees,or who recommend such action,or who are substantially discriminatory wage practices. involved in such action,will be made fully cognizant of,and will implement,the contractor's EEO policy and contractual c. The contractor will periodically review selected personnel responsibilities to provide EEO in each grade and classification of actions in depth to determine whether there is evidence of employment. To ensure that the above agreement will be met,the discrimination. Where evidence is found,the contractor will following actions will be taken as a minimum: promptly take corrective action. If the review indicates that the discrimination may extend beyond the actions reviewed,such a. Periodic meetings of supervisory and personnel office corrective action shall include all affected persons. employees will be conducted before the start of work and then not less often than once every six months,at which time the contractor's d. The contractor will promptly investigate all complaints of EEO policy and its implementation will be reviewed and explained. alleged discrimination made to the contractor in connection with its The meetings will be conducted by the EEO Officer. obligations under this contract,will attempt to resolve such complaints,and will take appropriate corrective action within a b. All new supervisory or personnel office employees will be given reasonable time. If the investigation indicates that the discrimination a thorough indoctrination by the EEO Officer,covering all major may affect persons other than the complainant,such corrective aspects of the contractor's EEO obligations within thirty days action shall include such other persons. Upon completion of each following their reporting for duty with the contractor. investigation,the contractor will inform every complainant of all of their avenues of appeal. c. All personnel who are engaged in direct recruitment for the project will be instructed by the EEO Officer in the contractor's 6.Training and Promotion: procedures for locating and hiring minorities and women. a. The contractor will assist in locating,qualifying,and increasing d. Notices and posters setting forth the contractor's EEO policy the skills of minorities and women who are applicants for will be placed in areas readily accessible to employees,applicants employment or current employees. Such efforts should be aimed at for employment and potential employees. developing full journey level status employees in the type of trade or job classification involved. e. The contractor's EEO policy and the procedures to implement such policy will be brought to the attention of employees by means b. Consistent with the contractor's work force requirements and of meetings,employee handbooks,or other appropriate means. as permissible under Federal and State regulations,the contractor shall make full use of training programs,i.e.,apprenticeship,and on- 4.Recruitment:When advertising for employees,the contractor will the-job training programs for the geographical area of contract include in all advertisements for employees the notation:"An Equal performance. In the event a special provision for training is provided Opportunity Employer." All such advertisements will be placed in under this contract,this subparagraph will be superseded as publications having a large circulation among minorities and women indicated in the special provision. The contracting agency may in the area from which the project work force would normally be reserve training positions for persons who receive welfare derived. assistance in accordance with 23 U.S.C. 140(a). a. The contractor will,unless precluded by a valid bargaining c. The contractor will advise employees and applicants for agreement,conduct systematic and direct recruitment through public employment of available training programs and entrance and private employee referral sources likely to yield qualified requirements for each. minorities and women. To meet this requirement,the contractor will identify sources of potential minority group employees,and establish d. The contractor will periodically review the training and with such identified sources procedures whereby minority and promotion potential of employees who are minorities and women women applicants may be referred to the contractor for employment and will encourage eligible employees to apply for such training and consideration. promotion. b. In the event the contractor has a valid bargaining agreement 7.Unions: If the contractor relies in whole or in part upon unions as providing for exclusive hiring hall referrals,the contractor is a source of employees,the contractor will use good faith efforts to expected to observe the provisions of that agreement to the extent obtain the cooperation of such unions to increase opportunities for that the system meets the contractor's compliance with EEO minorities and women. Actions by the contractor,either directly or contract provisions. Where implementation of such an agreement through a contractor's association acting as agent,will include the has the effect of discriminating against minorities or women,or procedures set forth below: obligates the contractor to do the same,such implementation violates Federal nondiscrimination provisions. a. The contractor will use good faith efforts to develop,in cooperation with the unions,joint training programs aimed toward c. The contractor will encourage its present employees to refer qualifying more minorities and women for membership in the unions minorities and women as applicants for employment. Information and increasing the skills of minorities and women so that they may and procedures with regard to referring such applicants will be qualify for higher paying employment. discussed with employees. b. The contractor will use good faith efforts to incorporate an EEO 5.Personnel Actions:Wages,working conditions,and employee clause into each union agreement to the end that such union will be benefits shall be established and administered,and personnel contractually bound to refer applicants without regard to their race, actions of every type,including hiring,upgrading,promotion, color,religion,sex,national origin,age or disability. transfer,demotion,layoff,and termination,shall be taken without regard to race,color,religion,sex,national origin,age or disability. c. The contractor is to obtain information as to the referral The following procedures shall be followed: practices and policies of the labor union except that to the extent such information is within the exclusive possession of the labor a. The contractor will conduct periodic inspections of project sites union and such labor union refuses to furnish such information to the to insure that working conditions and employee facilities do not contractor,the contractor shall so certify to the contracting agency indicate discriminatory treatment of project site personnel. and shall set forth what efforts have been made to obtain such information. Spc09-43 F- 11 Local Assistance Procedures Manual Exhibit 12-G Required Federal-aid Contract Language d. In the event the union is unable to provide the contractor with a b. The contractors and subcontractors will submit an annual reasonable flow of referrals within the time limit set forth in the report to the contracting agency each July for the duration of the collective bargaining agreement,the contractor will,through project,indicating the number of minority,women,and non-minority independent recruitment efforts,fill the employment vacancies group employees currently engaged in each work classification without regard to race,color,religion,sex,national origin,age or required by the contract work. This information is to be reported on disability;making full efforts to obtain qualified and/or qualifiable Form FHWA-1391. The staffing data should represent the project minorities and women. The failure of a union to provide sufficient work force on board in all or any part of the last payroll period referrals(even though it is obligated to provide exclusive referrals preceding the end of July. If on-the-job training is being required by under the terms of a collective bargaining agreement)does not special provision,the contractor will be required to collect and report relieve the contractor from the requirements of this paragraph. In training data. The employment data should reflect the work force on the event the union referral practice prevents the contractor from board during all or any part of the last payroll period preceding the meeting the obligations pursuant to Executive Order 11246,as end of July. amended,and these special provisions,such contractor shall immediately notify the contracting agency. III.NONSEGREGATED FACILITIES 8. Reasonable Accommodation for Applicants/Employees with Disabilities: The contractor must be familiar with the This provision is applicable to all Federal-aid construction contracts requirements for and comply with the Americans with Disabilities Act and to all related construction subcontracts of$10,000 or more. and all rules and regulations established there under. Employers must provide reasonable accommodation in all employment The contractor must ensure that facilities provided for employees activities unless to do so would cause an undue hardship. are provided in such a manner that segregation on the basis of race, color,religion,sex,or national origin cannot result. The contractor 9.Selection of Subcontractors,Procurement of Materials and may neither require such segregated use by written or oral policies Leasing of Equipment:The contractor shall not discriminate on the nor tolerate such use by employee custom. The contractor's grounds of race,color,religion,sex,national origin,age or disability obligation extends further to ensure that its employees are not in the selection and retention of subcontractors,including assigned to perform their services at any location,under the procurement of materials and leases of equipment. The contractor contractor's control,where the facilities are segregated. The term shall take all necessary and reasonable steps to ensure "facilities"includes waiting rooms,work areas,restaurants and other nondiscrimination in the administration of this contract. eating areas,time clocks,restrooms,washrooms,locker rooms,and other storage or dressing areas,parking lots,drinking fountains, a. The contractor shall notify all potential subcontractors and recreation or entertainment areas,transportation,and housing suppliers and lessors of their EEO obligations under this contract. provided for employees. The contractor shall provide separate or single-user restrooms and necessary dressing or sleeping areas to b. The contractor will use good faith efforts to ensure assure privacy between sexes. subcontractor compliance with their EEO obligations. IV. DAVIS-BACON AND RELATED ACT PROVISIONS 10. Assurance Required by 49 CFR 26.13(b): a. The requirements of 49 CFR Part 26 and the State DOT's U.S. This section is applicable to all Federal-aid construction projects DOT-approved DBE program are incorporated by reference. exceeding$2,000 and to all related subcontracts and lower-tier subcontracts(regardless of subcontract size). The requirements b. The contractor or subcontractor shall not discriminate on the apply to all projects located within the right-of-way of a roadway that basis of race,color,national origin,or sex in the performance of this is functionally classified as Federal-aid highway. This excludes contract. The contractor shall carry out applicable requirements of roadways functionally classified as local roads or rural minor 49 CFR Part 26 in the award and administration of DOT-assisted collectors,which are exempt. Contracting agencies may elect to contracts. Failure by the contractor to carry out these requirements apply these requirements to other projects. is a material breach of this contract,which may result in the termination of this contract or such other remedy as the contracting The following provisions are from the U.S. Department of Labor agency deems appropriate. regulations in 29 CFR 5.5"Contract provisions and related matters" with minor revisions to conform to the FHWA-1273 format and 11.Records and Reports:The contractor shall keep such records FHWA program requirements. as necessary to document compliance with the EEO requirements. 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 1. Minimum wages and shall be available at reasonable times and places for inspection by authorized representatives of the contracting agency and the a. All laborers and mechanics employed or working upon the site FHWA. of the work,will be paid unconditionally and not less often than once a week,and without subsequent deduction or rebate on any account a. The records kept by the contractor shall document the (except such payroll deductions as are permitted by regulations following: issued by the Secretary of Labor under the Copeland Act(29 CFR part 3)),the full amount of wages and bona fide fringe benefits(or (1)The number and work hours of minority and non-minority cash equivalents thereof)due at time of payment computed at rates group members and women employed in each work classification not less than those contained in the wage determination of the on the project; Secretary of Labor which is attached hereto and made a part hereof, regardless of any contractual relationship which may be alleged to (2)The progress and efforts being made in cooperation with exist between the contractor and such laborers and mechanics. unions,when applicable,to increase employment opportunities for minorities and women;and Contributions made or costs reasonably anticipated for bona fide (3)The progress and efforts being made in locating,hiring, fringe benefits under section 1(b)(2)of the Davis-Bacon Act on training,qualifying,and upgrading minorities and women; behalf of laborers or mechanics are considered wages paid to such laborers or mechanics,subject to the provisions of paragraph 1.d.of this section;also,regular contributions made or costs incurred for Spc09-43 F- 12 Local Assistance Procedures Manual Exhibit 12-G Required Federal-aid Contract Language more than a weekly period(but not less often than quarterly)under not expressed as an hourly rate,the contractor shall either pay the plans,funds,or programs which cover the particular weekly period, benefit as stated in the wage determination or shall pay another are deemed to be constructively made or incurred during such bona fide fringe benefit or an hourly cash equivalent thereof. weekly period.Such laborers and mechanics shall be paid the appropriate wage rate and fringe benefits on the wage determination d.If the contractor does not make payments to a trustee or other for the classification of work actually performed,without regard to third person,the contractor may consider as part of the wages of skill,except as provided in 29 CFR 5.5(a)(4).Laborers or mechanics any laborer or mechanic the amount of any costs reasonably performing work in more than one classification may be anticipated in providing bona fide fringe benefits under a plan or compensated at the rate specified for each classification for the time program,Provided,That the Secretary of Labor has found,upon the actually worked therein:Provided,That the employer's payroll written request of the contractor,that the applicable standards of the records accurately set forth the time spent in each classification in Davis-Bacon Act have been met.The Secretary of Labor may which work is performed.The wage determination(including any require the contractor to set aside in a separate account assets for additional classification and wage rates conformed under paragraph the meeting of obligations under the plan or program. 1.b.of this section)and the 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 prominent and accessible place where it can be 2. Withholding easily seen by the workers. The contracting agency shall upon its own action or upon written b. (1)The contracting officer shall require that any class of request of an authorized representative of the Department of Labor, laborers or mechanics,including helpers,which is not listed in the withhold or cause to be withheld from the contractor under this wage determination and which is to be employed under the contract contract,or any other Federal contract with the same prime shall be classified in conformance with the wage determination.The contractor,or any other federally-assisted contract subject to Davis- contracting officer shall approve an additional classification and Bacon prevailing wage requirements,which is held by the same wage rate and fringe benefits therefore only when the following prime contractor,so much of the accrued payments or advances as criteria have been met: may be considered necessary to pay laborers and mechanics, including apprentices,trainees,and helpers,employed by the (i)The work to be performed by the classification requested is contractor or any subcontractor the full amount of wages required by not performed by a classification in the wage determination;and the contract. In the event of failure to pay any laborer or mechanic, including any apprentice,trainee,or helper,employed or working on the site of the work,all or part of the wages required by the contract, (ii)The classification is utilized in the area by the construction the contracting agency may,after written notice to the contractor, industry;and take such action as may be necessary to cause the suspension of any further payment,advance,or guarantee of funds until such (iii)The proposed wage rate,includinganybona fide fringe violations have ceased. P P 9 9 benefits,bears a reasonable relationship to the wage rates contained in the wage determination. 3. Payrolls and basic records (2)If the contractor and the laborers and mechanics to be a. Payrolls and basic records relating thereto shall be maintained employed in the classification(if known),or their representatives, by the contractor during the course of the work and preserved for a and the contracting officer agree on the classification and wage period of three years thereafter for all laborers and mechanics rate(including the amount designated for fringe benefits where working at the site of the work.Such records shall contain the name, appropriate),a report of the action taken shall be sent by the address,and social security number of each such worker,his or her contracting officer to the Administrator of the Wage and Hour correct classification,hourly rates of wages paid(including rates of Division,Employment Standards Administration,U.S. Department contributions or costs anticipated for bona fide fringe benefits or of Labor,Washington, DC 20210.The Administrator,or an cash equivalents thereof of the types described in section 1(b)(2)(B) authorized representative,will approve,modify,or disapprove of the Davis-Bacon Act),daily and weekly number of hours worked, every additional classification action within 30 days of receipt and deductions made and actual wages paid.Whenever the Secretary of so advise the contracting officer or will notify the contracting officer Labor has found under 29 CFR 5.5(a)(1)(iv)that the wages of any within the 30-day period that additional time is necessary. laborer or mechanic include the amount of any costs reasonably anticipated in providing benefits under a plan or program described (3)In contractor,the laborers or mechanics to be in section 1(b)(2)(B)of the Davis-Bacon Act,the contractor shall employed 3)Ithe in the event the contractor, n or their representatives,rsoand the maintain records which show that the commitment to provide such contracting officer do not agree on the proposed classification and responsible,e s enforceable,atpl n o prolan roprogram a financially cated wage rate(including the amount designated for fringe benefits, n writintandelaborers tr the plan cr anicsaff has been records which where appropriate),the contracting officer shall refer the sow theg to theraidrs dr mechanics affected,andrrin pro iii which questions,including the views of all interested parties and the show the costs anticipated or the actual cost incurred in providing recommendation of the contracting officer,to the Wage and Hour such benefits.dprogramsContrshall employing apprentices or oftthe under Administrator for determination.The Wage and Hour approved shall maintain written evidence the Administrator,or an authorized representative,will issue a registration of apprenticeship programs and certification of trainee programs,the registration of the apprentices and trainees,and the determination within 30 days of receipt and so advise the contracting officer or will notify the contracting officer within the 30- ratios and wage rates prescribed in the applicable programs. day period that additional time is necessary. b. (1)The contractor shall submit weekly for each week in which (4)The wage rate(including fringe benefits where appropriate) any contract work is performed a copy of all payrolls to the to paragraphs 1 1 of this contracting agency. The payrolls submitted shall set out accurately section,determinedshpursuantll e paid to all paragraphs workers 1.bper(2)r work in the and completely all of the information required to be maintained classification under this contract from the first day on which work under 29 CFR 5.5(a)(3)(i),except that full social security numbers performed in the classification. and home addresses shall not be included on weekly transmittals. is Instead the payrolls shall only need to include an individually identifying number for each employee(e.g.,the last four digits of c.Whenever the minimum wage rate prescribed in the contract for the employee's social security number).The required weekly payroll a class of laborers or mechanics includes a fringe benefit which is information may be submitted in any form desired.Optional Form Spc09-43 F- 13 Local Assistance Procedures Manual Exhibit 12-G Required Federal-aid Contract Language WH-347 is available for this purpose from the Wage and Hour Apprentices will be permitted to work at less than the predetermined Division Web site at rate for the work they performed when they are employed pursuant http://www.dol.gov/esa/whd/forms/wh347instr.htm or its successor to and individually registered in a bona fide apprenticeship program site.The prime contractor is responsible for the submission of registered with the U.S.Department of Labor,Employment and copies of payrolls by all subcontractors.Contractors and Training Administration,Office of Apprenticeship Training,Employer subcontractors shall maintain the full social security number and and Labor Services,or with a State Apprenticeship Agency current address of each covered worker,and shall provide them recognized by the Office,or if a person is employed in his or her first upon request to the contracting agency for transmission to the State 90 days of probationary employment as an apprentice in such an DOT,the FHWA or the Wage and Hour Division of the Department apprenticeship program,who is not individually registered in the of Labor for purposes of an investigation or audit of compliance with program,but who has been certified by the Office of Apprenticeship prevailing wage requirements.It is not a violation of this section for a Training,Employer and Labor Services or a State Apprenticeship prime contractor to require a subcontractor to provide addresses Agency(where appropriate)to be eligible for probationary and social security numbers to the prime contractor for its own employment as an apprentice. records,without weekly submission to the contracting agency.. The allowable ratio of apprentices to journeymen on the job site in (2)Each payroll submitted shall be accompanied by a"Statement of any craft classification shall not be greater than the ratio permitted to Compliance,"signed by the contractor or subcontractor or his or her the contractor as to the entire work force under the registered agent who pays or supervises the payment of the persons employed program.Any worker listed on a payroll at an apprentice wage rate, under the contract and shall certify the following: who is not registered or otherwise employed as stated above,shall be paid not less than the applicable wage rate on the wage (i)That the payroll payroll period the determination for the classification of work actually performed.In information requiredaforto the providedpayrounder contains th ii) addition,any apprentice performing work on the job site in excess of infer Regulations,29 CFR part 5,the apunder§5.5 riate information 5a)(3) ofis being the ratio permitted under the registered program shall be paid not maintained under§5.5(a)(3)(i)of Regulations,29 CFR part 5, less than the applicable wage rate on the wage determination for the and that such information is correct and complete; work actually performed.Where a contractor is performing construction on a project in a locality other than that in which its program is registered,the ratios and wage rates(expressed in (ii)That each laborer or mechanic(including each helper, percentages of the journeyman's hourly rate)specified in the apprentice,and trainee)employed on the contract during the contractor's or subcontractor's registered program shall be payroll period has been paid the full weekly wages earned, observed. without rebate,either directly or indirectly,and that no deductions have been made either directly or indirectly from the Every apprentice must be paid at not less than the rate specified in full wages earned,other than permissible deductions as set forth the registered program for the apprentice's level of progress, in Regulations,29 CFR part 3; expressed as a percentage of the journeymen hourly rate specified in the applicable wage determination.Apprentices shall be paid (iii)That each laborer or mechanic has been paid not less fringe benefits in accordance with the provisions of the than the applicable wage rates and fringe benefits or cash apprenticeship program.If the apprenticeship program does not equivalents for the classification of work performed,as specified specify fringe benefits,apprentices must be paid the full amount of in the applicable wage determination incorporated into the fringe benefits listed on the wage determination for the applicable contract. classification. If the Administrator determines that a different practice prevails for the applicable apprentice classification,fringes shall be (3)The weekly submission of a properly executed certification paid in accordance with that determination. set forth on the reverse side of Optional Form WH-347 shall satisfy the requirement for submission of the"Statement of In the event the Office of Apprenticeship Training,Employer and Compliance"required by paragraph 3.b.(2)of this section. Labor Services,or a State Apprenticeship Agency recognized by the Office,withdraws approval of an apprenticeship program,the (4) falsification of the above contractor will no longer be permitted to utilize apprentices at less subject4)The the contractor ofanysubcontractorfthe to civil certificationsr criminal may than the applicable predetermined rate for the work performed until prosecution under section 1001 of title 18 and section 231 of title an acceptable program is approved. 31 of the United States Code. b.Trainees(programs of the USDOL). c.The contractor or subcontractor shall make the records required under paragraph 3.a.of this section available for inspection, Except as provided in 29 CFR 5.16,trainees will not be permitted to copying,or transcription by authorized representatives of the work at less than the predetermined rate for the work performed contracting agency,the State DOT,the FHWA, or the Department unless they are employed pursuant to and individually registered in of Labor,and shall permit such representatives to interview a program which has received prior approval,evidenced by formal employees during working hours on the job.If the contractor or certification by the U.S.Department of Labor,Employment and subcontractor fails to submit the required records or to make them Training Administration. available,the FHWA may,after written notice to the contractor,the contracting agency or the State DOT,take such action as may be The ratio of trainees to journeymen on the job site shall not be necessary to cause the suspension of any further payment, greater than permitted under the plan approved by the Employment advance,or guarantee of funds.Furthermore,failure to submit the and Training Administration. required records upon request or to make such records available may be grounds for debarment action pursuant to 29 CFR 5.12. Every trainee must be paid at not less than the rate specified in the 4. Apprentices and trainees approved program for the trainee's level of progress,expressed as a percentage of the journeyman hourly rate specified in the applicable wage determination.Trainees shall be paid fringe benefits in a.Apprentices(programs of the USDOL). accordance with the provisions of the trainee program.If the trainee program does not mention fringe benefits,trainees shall be paid the full amount of fringe benefits listed on the wage determination Spc09-43 F- 14 Local Assistance Procedures Manual Exhibit 12-G Required Federal-aid Contract Language unless the Administrator of the Wage and Hour Division determines a. By entering into this contract,the contractor certifies that neither it that there is an apprenticeship program associated with the (nor he or she)nor any person or firm who has an interest in the corresponding journeyman wage rate on the wage determination contractor's firm is a person or firm ineligible to be awarded which provides for less than full fringe benefits for apprentices.Any Government contracts by virtue of section 3(a)of the Davis-Bacon employee listed on the payroll at a trainee rate who is not registered Act or 29 CFR 5.12(a)(1). and participating in a training plan approved by the Employment and Training Administration shall be paid not less than the applicable b.No part of this contract shall be subcontracted to any person or wage rate on the wage determination for the classification of work firm ineligible for award of a Govemment contract by virtue of actually performed.In addition,any trainee performing work on the section 3(a)of the Davis-Bacon Act or 29 CFR 5.12(a)(1). job site in excess of the ratio permitted under the registered program shall be paid not less than the applicable wage rate on the wage determination for the work actually performed. c.The penalty for making false statements is prescribed in the U.S. Criminal Code, 18 U.S.C. 1001. In the event the Employment and Training Administration withdraws approval of a training program,the contractor will no longer be permitted to utilize trainees at less than the applicable predetermined rate for the work performed until an acceptable V. CONTRACT WORK HOURS AND SAFETY STANDARDS ACT program is approved. The following clauses apply to any Federal-aid construction contract c.Equal employment opportunity.The utilization of apprentices, in an amount in excess of$100,000 and subject to the overtime trainees and journeymen under this part shall be in conformity with provisions of the Contract Work Hours and Safety Standards Act. the equal employment opportunity requirements of Executive Order These clauses shall be inserted in addition to the clauses required 11246,as amended,and 29 CFR part 30. by 29 CFR 5.5(a)or 29 CFR 4.6. As used in this paragraph,the terms laborers and mechanics include watchmen and guards. d. Apprentices and Trainees(programs of the U.S.DOT). 1.Overtime requirements. No contractor or subcontractor Apprentices and trainees working under apprenticeship and skill contracting for any part of the contract work which may require or training programs which have been certified by the Secretary of involve the employment of laborers or mechanics shall require or Transportation as promoting EEO in connection with Federal-aid permit any such laborer or mechanic in any workweek in which he or highway construction programs are not subject to the requirements she is employed on such work to work in excess of forty hours in of paragraph 4 of this Section IV.The straight time hourly wage such workweek unless such laborer or mechanic receives rates for apprentices and trainees under such programs will be compensation at a rate not less than one and one-half times the established by the particular programs.The ratio of apprentices and basic rate of pay for all hours worked in excess of forty hours in such trainees to journeymen shall not be greater than permitted by the workweek. terms of the particular program. 2.Violation;liability for unpaid wages;liquidated damages. In 5.Compliance with Copeland Act requirements. The contractor the event of any violation of the clause set forth in paragraph(1.)of shall comply with the requirements of 29 CFR part 3,which are this section,the contractor and any subcontractor responsible incorporated by reference in this contract. therefor shall be liable for the unpaid wages. In addition,such contractor and subcontractor shall be liable to the United States(in the case of work done under contract for the District of Columbia or 6.Subcontracts. The contractor or subcontractor shall insert Form a territory,to such District or to such territory),for liquidated FHWA-1273 in any subcontracts and also require the subcontractors damages.Such liquidated damages shall be computed with respect to include Form FHWA-1273 in any lower tier subcontracts.The to each individual laborer or mechanic,including watchmen and prime contractor shall be responsible for the compliance by any guards,employed in violation of the clause set forth in paragraph subcontractor or lower tier subcontractor with all the contract (1.)of this section,in the sum of$10 for each calendar day on which clauses in 29 CFR 5.5. such individual was required or permitted to work in excess of the standard workweek of forty hours without payment of the overtime 7.Contract termination:debarment. A breach of the contract wages required by the clause set forth in paragraph(1.)of this clauses in 29 CFR 5.5 may be grounds for termination of the section. contract,and for debarment as a contractor and a subcontractor as provided in 29 CFR 5.12. 3.Withholding for unpaid wages and liquidated damages.The FHWA or the contacting agency shall upon its own action or upon 8.Compliance with Davis-Bacon and Related Act requirements. written request of an authorized representative of the Department of All rulings and interpretations of the Davis-Bacon and Related Acts Labor withhold or cause to be withheld,from any moneys payable contained in 29 CFR parts 1,3,and 5 are herein incorporated by on account of work performed by the contractor or subcontractor reference in this contract. under any such contract or any other Federal contract with the same prime contractor,or any other federally-assisted contract subject to the Contract Work Hours and Safety Standards Act,which is held by 9.Disputes concerning labor standards.Disputes arising out of the same prime contractor,such sums as may be determined to be the labor standards provisions of this contract shall not be subject to necessary to satisfy any liabilities of such contractor or the general disputes clause of this contract.Such disputes shall be subcontractor for unpaid wages and liquidated damages as provided resolved in accordance with the procedures of the Department of in the clause set forth in paragraph(2.)of this section. Labor set forth in 29 CFR parts 5,6,and 7. Disputes within the meaning of this clause include disputes between the contractor(or 4.Subcontracts. The contractor or subcontractor shall insert in any any of its subcontractors)and the contracting agency,the U.S. subcontracts the clauses set forth in paragraph(1.)through(4.)of Department of Labor,or the employees or their representatives. this section and also a clause requiring the subcontractors to include these clauses in any lower tier subcontracts.The prime contractor 10.Certification of eligibility. shall be responsible for compliance by any subcontractor or lower tier subcontractor with the clauses set forth in paragraphs(1.) through(4.)of this section. Spc09-43 F- 15 Local Assistance Procedures Manual Exhibit 12-G Required Federal-aid Contract Language VII.SAFETY:ACCIDENT PREVENTION VI.SUBLETTING OR ASSIGNING THE CONTRACT This provision is applicable to all Federal-aid construction contracts and to all related subcontracts. This provision is applicable to all Federal-aid construction contracts on the National Highway System. 1. In the performance of this contract the contractor shall comply with all applicable Federal,State,and local laws governing safety, 1.The contractor shall perform with its own organization contract health,and sanitation(23 CFR 635).The contractor shall provide all work amounting to not less than 30 percent(or a greater percentage safeguards,safety devices and protective equipment and take any if specified elsewhere in the contract)of the total original contract other needed actions as it determines,or as the contracting officer price,excluding any specialty items designated by the contracting may determine,to be reasonably necessary to protect the life and agency. Specialty items may be performed by subcontract and the health of employees on the job and the safety of the public and to amount of any such specialty items performed may be deducted protect property in connection with the performance of the work from the total original contract price before computing the amount of covered by the contract. work required to be performed by the contractor's own organization (23 CFR 635.116). 2. It is a condition of this contract,and shall be made a condition of each subcontract,which the contractor enters into pursuant to this a. The term"perform work with its own organization"refers to contract,that the contractor and any subcontractor shall not permit workers employed or leased by the prime contractor,and equipment any employee,in performance of the contract,to work in owned or rented by the prime contractor,with or without operators. surroundings or under conditions which are unsanitary,hazardous Such term does not include employees or equipment of a or dangerous to his/her health or safety,as determined under subcontractor or lower tier subcontractor,agents of the prime construction safety and health standards(29 CFR 1926) contractor,or any other assignees. The term may include payments promulgated by the Secretary of Labor,in accordance with Section for the costs of hiring leased employees from an employee leasing 107 of the Contract Work Hours and Safety Standards Act(40 firm meeting all relevant Federal and State regulatory requirements. U.S.C.3704). Leased employees may only be included in this term if the prime contractor meets all of the following conditions: 3.Pursuant to 29 CFR 1926.3,it is a condition of this contract that the Secretary of Labor or authorized representative thereof,shall (1)the prime contractor maintains control over have right of entry to any site of contract performance to inspect or the supervision of the day-to-day activities of the leased employees; investigate the matter of compliance with the construction safety and (2)the prime contractor remains responsible for the quality of health standards and to carry out the duties of the Secretary under the work of the leased employees; Section 107 of the Contract Work Hours and Safety Standards Act (3)the prime contractor retains all power to accept or exclude (40 U.S.C.3704). individual employees from work on the project;and (4)the prime contractor remains ultimately responsible for the payment of predetermined minimum wages,the submission of VIII.FALSE STATEMENTS CONCERNING HIGHWAY PROJECTS payrolls,statements of compliance and all other Federal regulatory requirements. This provision is applicable to all Federal-aid construction contracts and to all related subcontracts. b."Specialty Items"shall be construed to be limited to work that requires highly specialized knowledge,abilities,or equipment not In order to assure high quality and durable construction in ordinarily available in the type of contracting organizations qualified conformity with approved plans and specifications and a high degree and expected to bid or propose on the contract as a whole and in of reliability on statements and representations made by engineers, general are to be limited to minor components of the overall contractors,suppliers,and workers on Federal-aid highway projects, contract. it is essential that all persons concerned with the project perform their functions as carefully,thoroughly,and honestly as possible. 2.The contract amount upon which the requirements set forth in Willful falsification,distortion,or misrepresentation with respect to paragraph(1)of Section VI is computed includes the cost of material any facts related to the project is a violation of Federal law. To and manufactured products which are to be purchased or produced prevent any misunderstanding regarding the seriousness of these by the contractor under the contract provisions. and similar acts,Form FHWA-1022 shall be posted on each Federal-aid highway project(23 CFR 635)in one or more places 3.The contractor shall furnish(a)a competent superintendent or where it is readily available to all persons concerned with the supervisor who is employed by the firm,has full authority to direct project: performance of the work in accordance with the contract requirements,and is in charge of all construction operations (regardless of who performs the work)and(b)such other of its own 18 U.S.C. 1020 reads as follows: organizational resources(supervision,management,and engineering services)as the contracting officer determines is 'Whoever,being an officer,agent,or employee of the United necessary to assure the performance of the contract. States,or of any State or Territory,or whoever,whether a person, association,firm,or corporation,knowingly makes any false 4.No portion of the contract shall be sublet,assigned or otherwise statement,false representation,or false report as to the character, disposed of except with the written consent of the contracting officer, quality,quantity,or cost of the material used or to be used,or the or authorized representative,and such consent when given shall not quantity or quality of the work performed or to be performed,or the be construed to relieve the contractor of any responsibility for the cost thereof in connection with the submission of plans,maps, fulfillment of the contract. Written consent will be given only after specifications,contracts,or costs of construction on any highway or the contracting agency has assured that each subcontract is related project submitted for approval to the Secretary of evidenced in writing and that it contains all pertinent provisions and Transportation;or requirements of the prime contract. Whoever knowingly makes any false statement,false 5.The 30%self-performance requirement of paragraph(1)is not representation,false report or false claim with respect to the applicable to design-build contracts;however,contracting agencies character,quality,quantity,or cost of any work performed or to be may establish their own self-performance requirements. performed,or materials furnished or to be furnished,in connection Spc09-43 F- 16 Local Assistance Procedures Manual Exhibit 12-G Required Federal-aid Contract Language with the construction of any highway or related project approved by the Secretary of Transportation;or e.The terms"covered transaction,""debarred,""suspended," "ineligible,""participant,""person," "principal,"and"voluntarily Whoever knowingly makes any false statement or false excluded,"as used in this clause,are defined in 2 CFR Parts 180 representation as to material fact in any statement,certificate,or and 1200. "First Tier Covered Transactions"refers to any covered report submitted pursuant to provisions of the Federal-aid Roads Act transaction between a grantee or subgrantee of Federal funds and a approved July 1, 1916,(39 Stat.355),as amended and participant(such as the prime or general contract). "Lower Tier supplemented; Covered Transactions"refers to any covered transaction under a First Tier Covered Transaction(such as subcontracts). "First Tier Shall be fined under this title or imprisoned not more than 5 years Participant"refers to the participant who has entered into a covered or both." transaction with a grantee or subgrantee of Federal funds(such as the prime or general contractor). "Lower Tier Participant"refers any participant who has entered into a covered transaction with a First IX.IMPLEMENTATION OF CLEAN AIR ACT AND FEDERAL Tier Participant or other Lower Tier Participants(such as WATER POLLUTION CONTROL ACT subcontractors and suppliers). This provision is applicable to all Federal-aid construction contracts f.The prospective first tier participant agrees by submitting this and to all related subcontracts. proposal that,should the proposed covered transaction be entered into,it shall not knowingly enter into any lower tier covered By submission of this bid/proposal or the execution of this contract, transaction with a person who is debarred,suspended,declared or subcontract,as appropriate,the bidder,proposer,Federal-aid ineligible,or voluntarily excluded from participation in this covered construction contractor,or subcontractor,as appropriate,will be transaction,unless authorized by the department or agency entering deemed to have stipulated as follows: into this transaction. 1.That any person who is or will be utilized in the performance of g.The prospective first tier participant further agrees by this contract is not prohibited from receiving an award due to a submitting this proposal that it will include the clause titled violation of Section 508 of the Clean Water Act or Section 306 of the "Certification Regarding Debarment,Suspension,Ineligibility and Clean Air Act. Voluntary Exclusion-Lower Tier Covered Transactions,"provided by 2.That the contractor agrees to include or cause to be included the the department or contracting agency,entering into this covered requirements of paragraph(1)of this Section X in every subcontract, transaction,without modification,in all lower tier covered and further agrees to take such action as the contracting agency transactions and in all solicitations for lower tier covered may direct as a means of enforcing such requirements. transactions exceeding the$25,000 threshold. h.A participant in a covered transaction may rely upon a X.CERTIFICATION REGARDING DEBARMENT,SUSPENSION, certification of a prospective participant in a lower tier covered INELIGIBILITY AND VOLUNTARY EXCLUSION transaction that is not debarred,suspended,ineligible,or voluntarily excluded from the covered transaction,unless it knows that the This provision is applicable to all Federal-aid construction contracts, certification is erroneous. A participant is responsible for ensuring design-build contracts,subcontracts,lower-tier subcontracts, that its principals are not suspended,debarred,or otherwise purchase orders,lease agreements,consultant contracts or any ineligible to participate in covered transactions. To verify the other covered transaction requiring FHWA approval or that is eligibility of its principals,as well as the eligibility of any lower tier estimated to cost$25,000 or more— as defined in 2 CFR Parts 180 prospective participants,each participant may,but is not required to, and 1200. check the Excluded Parties List System website (https://www.epls.gov/),which is compiled by the General Services Administration. 1.Instructions for Certification—First Tier Participants: i. Nothing contained in the foregoing shall be construed to require the establishment of a system of records in order to render in good a.By signing and submitting this proposal,the prospective first faith the certification required by this clause.The knowledge and tier participant is providing the certification set out below. information of the prospective participant is not required to exceed that which is normally possessed by a prudent person in the b.The inability of a person to provide the certification set out ordinary course of business dealings. below will not necessarily result in denial of participation in this covered transaction.The prospective first tier participant shall j.Except for transactions authorized under paragraph(0 of these submit an explanation of why it cannot provide the certification set instructions,if a participant in a covered transaction knowingly out below.The certification or explanation will be considered in enters into a lower tier covered transaction with a person who is connection with the department or agency's determination whether suspended,debarred,ineligible,or voluntarily excluded from to enter into this transaction.However,failure of the prospective first participation in this transaction,in addition to other remedies tier participant to furnish a certification or an explanation shall available to the Federal Government,the department or agency may disqualify such a person from participation in this transaction. terminate this transaction for cause or default. c.The certification in this clause is a material representation of fact upon which reliance was placed when the contracting agency determined to enter into this transaction.If it is later determined that 2. Certification Regarding Debarment,Suspension,Ineligibility the prospective participant knowingly rendered an erroneous and Voluntary Exclusion—First Tier Participants: certification,in addition to other remedies available to the Federal Government,the contracting agency may terminate this transaction a. The prospective first tier participant certifies to the best of its for cause of default. knowledge and belief,that it and its principals: d.The prospective first tier participant shall provide immediate (1) Are not presently debarred,suspended,proposed for written notice to the contracting agency to whom this proposal is debarment,declared ineligible,or voluntarily excluded from submitted if any time the prospective first tier participant learns that participating in covered transactions by any Federal department or its certification was erroneous when submitted or has become agency; erroneous by reason of changed circumstances. Spc09-43 F- 17 Local Assistance Procedures Manual Exhibit 12-G Required Federal-aid Contract Language (2) Have not within a three-year period preceding this proposal solicitations for lower tier covered transactions exceeding the been convicted of or had a civil judgment rendered against them for $25,000 threshold. commission of fraud or a criminal offense in connection with obtaining,attempting to obtain,or performing a public(Federal, g.A participant in a covered transaction may rely upon a State or local)transaction or contract under a public transaction; certification of a prospective participant in a lower tier covered violation of Federal or State antitrust statutes or commission of transaction that is not debarred,suspended,ineligible,or voluntarily embezzlement,theft,forgery,bribery,falsification or destruction of excluded from the covered transaction,unless it knows that the records,making false statements,or receiving stolen property; certification is erroneous.A participant is responsible for ensuring that its principals are not suspended,debarred,or otherwise (3) Are not presently indicted for or otherwise criminally or civilly ineligible to participate in covered transactions. To verify the charged by a governmental entity(Federal,State or local)with eligibility of its principals,as well as the eligibility of any lower tier commission of any of the offenses enumerated in paragraph(a)(2) prospective participants,each participant may,but is not required to, of this certification;and check the Excluded Parties List System website (https://www.epls.gov/),which is compiled by the General Services (4) Have not within a three-year period preceding this Administration. application/proposal had one or more public transactions(Federal, State or local)terminated for cause or default. h.Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith b. Where the prospective participant is unable to certify to any of the certification required by this clause.The knowledge and the statements in this certification,such prospective participant shall information of participant is not required to exceed that which is attach an explanation to this proposal. normally possessed by a prudent person in the ordinary course of business dealings. 2.Instructions for Certification-Lower Tier Participants: i.Except for transactions authorized under paragraph e of these (Applicable to all subcontracts, purchase orders and other lower tier instructions,if a participant in a covered transaction knowingly transactions requiring prior FHWA approval or estimated to cost enters into a lower tier covered transaction with a person who is $25,000 or more-2 CFR Parts 180 and 1200) suspended,debarred,ineligible,or voluntarily excluded from participation in this transaction,in addition to other remedies a.By signing and submitting this proposal,the prospective lower available to the Federal Government,the department or agency with tier is providing the certification set out below. which this transaction originated may pursue available remedies, including suspension and/or debarment. b.The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into.If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification,in addition Certification Regarding Debarment,Suspension,Ineligibility to other remedies available to the Federal Government,the and Voluntary Exclusion—Lower Tier Participants: department,or agency with which this transaction originated may pursue available remedies,including suspension and/or debarment. 1.The prospective lower tier participant certifies,by submission of this proposal,that neither it nor its principals is presently debarred, c.The prospective lower tier participant shall provide immediate suspended,proposed for debarment,declared ineligible,or written notice to the person to which this proposal is submitted if at voluntarily excluded from participating in covered transactions by any time the prospective lower tier participant learns that its any Federal department or agency. certification was erroneous by reason of changed circumstances. 2.Where the prospective lower tier participant is unable to certify to d.The terms"covered transaction,""debarred,""suspended," any of the statements in this certification,such prospective "ineligible,""participant,""person,""principal,"and"voluntarily participant shall attach an explanation to this proposal. excluded,"as used in this clause,are defined in 2 CFR Parts 180 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 XI.CERTIFICATION REGARDING USE OF CONTRACT FUNDS between a grantee or subgrantee of Federal funds and a participant FOR LOBBYING (such as the prime or general contract). "Lower Tier Covered Transactions"refers to any covered transaction under a First Tier This provision is applicable to all Federal-aid construction contracts Covered Transaction(such as subcontracts). "First Tier Participant" and to all related subcontracts which exceed$100,000(49 CFR 20). refers to the participant who has entered into a covered transaction with a grantee or subgrantee of Federal funds(such as the prime or 1.The prospective participant certifies,by signing and submitting general contractor). "Lower Tier Participant"refers any participant this bid or proposal,to the best of his or her knowledge and belief, who has entered into a covered transaction with a First Tier that: Participant or other Lower Tier Participants(such as subcontractors and suppliers). a.No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned,to any person for influencing or e.The prospective lower tier participant agrees by submitting this attempting to influence an officer or employee of any Federal proposal that,should the proposed covered transaction be entered agency,a Member of Congress,an officer or employee of Congress, into,it shall not knowingly enter into any lower tier covered or an employee of a Member of Congress in connection with the transaction with a person who is debarred,suspended,declared awarding of any Federal contract,the making of any Federal grant, ineligible,or voluntarily excluded from participation in this covered the making of any Federal loan,the entering into of any cooperative transaction,unless authorized by the department or agency with agreement,and the extension,continuation,renewal,amendment, which this transaction originated. or modification of any Federal contract,grant,loan,or cooperative agreement. f.The prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled b.If any funds other than Federal appropriated funds have been "Certification Regarding Debarment,Suspension,Ineligibility and paid or will be paid to any person for influencing or attempting to Voluntary Exclusion-Lower Tier Covered Transaction,"without influence an officer or employee of any Federal agency,a Member modification,in all lower tier covered transactions and in all of Congress,an officer or employee of Congress,or an employee of Spc09-43 F- 18 Local Assistance Procedures Manual Exhibit 12-G Required Federal-aid Contract Language 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 Form to Report Lobbying,"in accordance with its instructions. 2.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 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 $100,000 and that all such recipients shall certify and disclose accordingly. Spc09-43 F- 19 Local Assistance Procedures Manual Exhibit 12-G Required Federal-aid Contract Language 12. FEMALE AND MINORITY GOALS To comply with Section II, "Nondiscrimination," of"Required Contract Provisions Federal-Aid Construction Contracts,"the following are goals for female and minority utilization goals for Federal-aid construction contracts and subcontracts that exceed$10,000: The nationwide goal for female utilization is 6.9 percent. The goals for minority utilization[45 Fed Reg 65984(10/3/1980)] are as follows: MINORITY UTILIZATION GOALS Goal Economic Area (Percent ) Redding CA: 174 Non-SMSA(Standard Metropolitan Statistical Area) Counties: 6.8 CA Lassen; CA Modoc; CA Plumas; CA Shasta; CA Siskiyou; CA Tehama Eureka, CA 175 Non-SMSA Counties: 6.6 CA Del Norte; CA Humboldt; CA Trinity San Francisco-Oakland-San Jose, CA: SMSA Counties: 7120 Salinas-Seaside-Monterey, CA 28.9 CA Monterey 7360 San Francisco-Oakland 25.6 CA Alameda; CA Contra Costa; CA Marin; CA San Francisco; CA San Mateo 7400 San Jose, CA 176 CA Santa Clara, CA 19.6 7485 Santa Cruz, CA CA Santa Cruz 14.9 7500 Santa Rosa CA Sonoma 9.1 8720 Vallejo-Fairfield-Napa, CA CA Napa; CA Solano 17.1 Non-SMSA Counties: CA Lake; CA Mendocino; CA San Benito 23.2 Sacramento, CA: SMSA Counties: 6920 Sacramento, CA 16.1 177 CA Placer; CA Sacramento; CA Yolo Non-SMSA Counties 14.3 CA Butte; CA Colusa; CA El Dorado; CA Glenn; CA Nevada; CA Sierra; CA Sutter; CA Yuba Stockton-Modesto, CA: SMSA Counties: 5170 Modesto, CA 12.3 178 CA Stanislaus 8120 Stockton, CA 24.3 CA San Joaquin Non-SMSA Counties 19.8 CA Alpine; CA Amador; CA Calaveras; CA Mariposa; CA Merced; CA Tuolumne Spc09-43 F-20 Local Assistance Procedures Manual Exhibit 12-G Required Federal-aid Contract Language Fresno-Bakersfield, CA SMSA Counties: 0680 Bakersfield, CA 19.1 179 CA Kem 2840 Fresno, CA 26.1 CA Fresno Non-SMSA Counties: 23.6 CA Kings; CA Madera; CA Tulare _ Los Angeles, CA: SMSA Counties: 0360 Anaheim-Santa Ana-Garden Grove, CA 11.9 CA Orange 4480 Los Angeles-Long Beach, CA 28.3 CA Los Angeles 180 6000 Oxnard-Simi Valley-Ventura, CA 21.5 CA Ventura 6780 Riverside-San Bernardino-Ontario, CA 19.0 CA Riverside; CA San Bernardino 7480 Santa Barbara-Santa Maria-Lompoc, CA 19.7 CA Santa Barbara Non-SMSA Counties 24.6 CA Inyo; CA Mono; CA San Luis Obispo San Diego, CA: SMSA Counties 181 7320 San Diego, CA 16.9 CA San Diego Non-SMSA Counties 18.2 CA Imperial For each July during which work is performed under the contract,you and each non material-supplier subcontractor with a subcontract of$10,000 or more must complete Form FHWA PR-1391 (Appendix C to 23 CFR 230). Submit the forms by August 15. 13. FEDERAL TRAINEE PROGRAM For the Federal training program,the number of trainees or apprentices is 0 . This section applies if a number of trainees or apprentices is specified in the special provisions. As part of your equal opportunity affirmative action program,provide on-the-job training to develop full journeymen in the types of trades or job classifications involved. You have primary responsibility for meeting this training requirement. If you subcontract a contract part, determine how many trainees or apprentices are to be trained by the subcontractor. Include these training requirements in your subcontract. Where feasible,25 percent of apprentices or trainees in each occupation must be in their 1st year of apprenticeship or training. Distribute the number of apprentices or trainees among the work classifications on the basis of your needs and the availability of journeymen in the various classifications within a reasonable recruitment area. Before starting work, submit to the City/County of • 1. Number of apprentices or trainees to be trained for each classification Spc09-43 F-21 Local Assistance Procedures Manual Exhibit 12-G Required Federal-aid Contract Language 2. Training program to be used 3. Training starting date for each classification Obtain the City/County's of approval for this submitted information before you start work. The City/County of credits you for each apprentice or trainee you employ on the work who is currently enrolled or becomes enrolled in an approved program. The primary objective of this section is to train and upgrade minorities and women toward journeymen status. Make every effort to enroll minority and women apprentices or trainees, such as conducting systematic and direct recruitment through public and private sources likely to yield minority and women apprentices or trainees,to the extent they are available within a reasonable recruitment area. Show that you have made the efforts. In making these efforts, do not discriminate against any applicant for training. Do not employ as an apprentice or trainee an employee: 1. In any classification in which the employee has successfully completed a training course leading to journeyman status or in which the employee has been employed as a journeyman 2. Who is not registered in a program approved by the US Department of Labor, Bureau of Apprenticeship and Training Ask the employee if the employee has successfully completed a training course leading to journeyman status or has been employed as a journeyman. Your records must show the employee's answers to the questions. In your training program, establish the minimum length and training type for each classification. The City/County of and FHWA approves a program if one of the following is met: 1. It is calculated to: • Meet the your equal employment opportunity responsibilities • Qualify the average apprentice or trainee for journeyman status in the classification involved by the end of the training period 2. It is registered with the U.S. Department of Labor,Bureau of Apprenticeship and Training, and it is administered in a way consistent with the equal employment responsibilities of Federal-aid highway construction contracts Obtain the State's approval for your training program before you start work involving the classification covered by the program. Provide training in the construction crafts,not in clerk-typist or secretarial-type positions. Training is allowed in lower level management positions such as office engineers,estimators, and timekeepers if the training is oriented toward construction applications. Training is allowed in the laborer classification if significant and meaningful training is provided and approved by the division office. Off-site training is allowed if the training is an integral part of an approved training program and does not make up a significant part of the overall training. The City/County of reimburses you 80 cents per hour of training given an employee on this contract under an approved training program: 1. For on-site training 2. For off-site training if the apprentice or trainee is currently employed on a Federal-aid project and you do at least one of the following: • Contribute to the cost of the training • Provide the instruction to the apprentice or trainee • Pay the apprentice's or trainee's wages during the off-site training period 3. If you comply this section. Each apprentice or trainee must: 1. Begin training on the project as soon as feasible after the start of work involving the apprentice's or trainee's skill Spc09-43 F-22 Local Assistance Procedures Manual Exhibit 12-G Required Federal-aid Contract Language 2. Remain on the project as long as training opportunities exist in the apprentice's or trainee's work classification or until the apprentice or trainee has completed the training program Furnish the apprentice or trainee: 1. Copy of the program you will comply with in providing the training 2. Certification showing the type and length of training satisfactorily completed 14. TITLE VI ASSURANCES During the performance of this Agreement,the contractor, for itself, its assignees and successors in interest(hereinafter collectively referred to as CONTRACTOR)agrees as follows: (1) Compliance with Regulations: CONTRACTOR shall comply with the regulations relative to nondiscrimination in federally assisted programs of the Department of Transportation,Title 49, Code of Federal Regulations,Part 21, as they may be amended from time to time, (hereinafter referred to as the REGULATIONS),which are herein incorporated by reference and made a part of this agreement. (2) Nondiscrimination: CONTRACTOR,with regard to the work performed by it during the AGREEMENT, shall not discriminate on the grounds of race, color, sex,national origin, religion, age, or disability in the selection and retention of sub-applicants, including procurements of materials and leases of equipment. CONTRACTOR shall not participate either directly or indirectly in the discrimination prohibited by Section 21.5 of the Regulations,including employment practices when the agreement covers a program set forth in Appendix B of the Regulations. (3) Solicitations for Sub-agreements, Including Procurements of Materials and Equipment: In all solicitations either by competitive bidding or negotiation made by CONTRACTOR for work to be performed under a Sub-agreement, including procurements of materials or leases of equipment, each potential sub-applicant or supplier shall be notified by CONTRACTOR of the CONTRACTOR'S obligations under this Agreement and the Regulations relative to nondiscrimination on the grounds of race, color,or national origin. (4) Information and Reports: CONTRACTOR shall provide all information and reports required by the Regulations,or directives issued pursuant thereto, and shall permit access to its books,records, accounts,other sources of information, and its facilities as may be determined by the California Department of Transportation or FHWA to be pertinent to ascertain compliance with such Regulations or directives. Where any information required of CONTRACTOR is in the exclusive possession of another who fails or refuses to furnish this information, CONTRACTOR shall so certify to the California Department of Transportation or the FHWA as appropriate,and shall set forth what efforts CONTRACTOR has made to obtain the information. (5) Sanctions for Noncompliance: In the event of CONTRACTOR's noncompliance with the nondiscrimination provisions of this agreement,the California Department of Transportation shall impose such agreement sanctions as it or the FHWA may determine to be appropriate, including,but not limited to: (a) withholding of payments to CONTRACTOR under the Agreement within a reasonable period of time,not to exceed 90 days; and/or (b) cancellation,termination or suspension of the Agreement, in whole or in part. (6) Incorporation of Provisions: CONTRACTOR shall include the provisions of paragraphs(1)through (6) in every sub-agreement, including procurements of materials and leases of equipment,unless exempt by the Regulations,or directives issued pursuant thereto. CONTRACTOR shall take such action with respect to any sub-agreement or procurement as the California Department of Transportation or FHWA may direct as a means of enforcing such provisions including sanctions for noncompliance,provided, however,that, in the event CONTRACTOR becomes involved in,or is threatened with,litigation with a sub-applicant or supplier as a result of such direction, CONTRACTOR may request the California Department of Transportation enter into such litigation to Spc09-43 F-23 Local Assistance Procedures Manual Exhibit 12-G Required Federal-aid Contract Language protect the interests of the State,and, in addition, CONTRACTOR may request the United States to enter into such litigation to protect the interests of the United States. MAINTAIN RECORDS AND SUBMIT REPORTS DOCUMENTING YOUR PERFORMANCE UNDER THIS SECTION Spc09-43 F-24 (THE BIDDER'S EXECUTION ON THE SIGNATURE PORTION OF THIS PROPOSAL SHALL ALSO CONSTITUTE AN ENDORSEMENT AND EXECUTION OF THIS CERTIFICATION, WHICH ISA PART OF THIS PROPOSAL.) EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder '/ proposed subcontractor hereby certifies that he has / 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, 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 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 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. Spc09-43 F-25 (THE BIDDER'S EXECUTION ON THE SIGNATURE PORTION OF THIS PROPOSAL SHALL ALSO CONSTITUTE AN ENDORSEMENT AND EXECUTION OF THIS CERTIFICATION, WHICH ISA PART OF THIS PROPOSAL.) DEBARMENT AND SUSPENSION CERTIFICATION TITLE 49, CODE OF FEDERAL REGULATIONS, PART 29 The bidder, under penalty of perjury, certifies that, except as noted below, he/she or any other 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. 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. Note: Providing false information may result in criminal prosecution or administrative sanctions. Spc09-43 F-26 (THE BIDDER'S EXECUTION ON THE SIGNATURE PORTION OF THIS PROPOSAL SHALL ALSO CONSTITUTE AN ENDORSEMENT AND EXECUTION OF THIS CERTIFICATION, WHICH ISA PART OF THIS PROPOSAL.) 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 $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. Spc09-43 F-27 DISCLOSURE OF LOBBYING ACTIVITIES COMPLETE THIS FORM TO DISCLOSE LOBBYING ACTIVITIES PURSUANT TO 31 U.S.C. 1352 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: El a.contract 1 . a.bid/offer/application a.initial b.grant b.initial award b.material change c.cooperative agreement c.post-award d.loan For Material Change Only: e.loan guarantee year quarter f. loan insurance date of last report 4. Name and Address of Reporting Entity 5. If Reporting Entity in No.4 is Subawardee, Enter Name and Address of Prime: Prime El Subawardee Tier , if known Congressional District,if known: Congressional District,if known: 6. Federal Department/Agency: 7. Federal Program Name/Description: 6IT� © 10,q-4)s VreP�f CFDA Number,if applicable 8. Federal Action Number,if known: 9. Award Amount,if known: $ 10. a. Name and Address of Lobbying Registrant b. Individuals Performing Services (including (If individual, last name, first name, MI): address if different from No. 10a) (last name, first name, MI): (attach Continuation Sheet(s)if necessary) 11. Amount of Payment(cher all that apply) 13. Type of Payment(check all that apply) $ ctual ❑ planned _ a. retainer _ b. one-time fee 12. Form of Payment(check all that apply): _ c. commission 8 a. cash _ d. contingent fee b. in-kind; specify: nature /U A e deferred value_r2ii other,specify No/1 c 14. Brief Description of Services Performed or to be performed and Date(s)of Service, including officer(s),employee(s),or member(s)contacted,for Payment Indicated in Item 11: (attach Continuation Sheet(s)if necess ry) 15. Continuation Sheet(s)attached: Yes 0 No 16. Information requested through this form is authorized by Title 31 /;16.4.--.40- U.S.C.Section 1352. This disclosure of lobbying reliance was Signature: placed by the tier above when his transaction was made or _ , / �� / entered into. This disclosure is required pursuant to 31 U.S.C. Print Name: ,�//�t_r/IJ/%C/1/9 1352. This information will be reported to Congress �� semiannually and will be available for public inspection. Any ,p s` person who fails to file the required disclosure shall be subject to Title: )/�x-40 A }-f a civil penalty of not less than$10,000 and not more than // ��`! $100,000 for each such failure. Telephone No.:7/f 7 -0jte Date:,*-k-- Authorized for Local Reproduction Federal Use Only: Standard Form-LLL Exhibit 12-E, Attachment G (3/15/01) Spc09-43 F-28 INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether subawardee 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 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 the tier of the subawardee, e.g., the first subawardee of the prime is the first tier. Subawards include but are not limited to subcontracts,sub-grants,and contract awards under grants. 5. If the organization filing the report in Item 4 checks "Subawardee," then enter the full name, address, city, state, and zip code of the prime Federal recipient. Include Congressional District, if known. 6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organization level below agency name, if known (e.g., 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 1 (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 influence 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(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(es). Check all boxes that apply. If payment is made through an in-kind contribution, specify the nature and value of the in-kind payment. 13. Check the appropriate box(es). Check all boxes that apply. If other, specify nature. 14. Provide a specific and detailed description of the services that the lobbyist has performed or will be expected to perform and the date(s)of any services rendered. Include all preparatory and related activity not just time spent 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 sheet is attached. 16. The certifying official shall sign and date the form, print his/her name title and telephone number. Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time 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. Spc09-43 F-29 Local Assistance Procedures Manual EXHIBIT 15-G Local Agency Bidder DBE Commitment(Construction Contracts) EXHIBIT 15-G LOCAL AGENCY BIDDER DBE COMMITMENT(CONSTRUCTION CONTRACTS) NOTE: PLEASE REFER TO INSTRUCTIONS ON THE REVERSE SIDE OFTTHISS�FORM LOCAL AGENCY:City of Rancho Palos Verdes LOCATION: ,(iIfj2e�� PROJECT DESCRIPTION:Hawthorne Boulevard Signal Synchronization Project TOTAL CONTRACT AMOUNT:$ ,'/2l.7< BID DATE: � cP//Y.�{' BIDDER'S NAME: CONTRACT DBE GOAL:6% CONTRACT ITEM OF WORK AND DESCRIPTION DBE CERT NO. NAME OF EACH DBE DOLLAR AMOUNT ITEM NO. OR SERVICES TO BE AND EXPIRATION (Must be certified on the date bids DBE SUBCONTRACTED OR MATERIALS DATE are opened-include DBE address TO BE PROVIDED(or contracted if the and phone number) bidder is a DBE) �Y‘ --,g ea e�6/� G, /�' ' Z4Iry 4ex(5-6-0�- 5/02 ,2 .qG 4. i�Jev /11- W-5°4=1.7/ A�di9yEir�.64.9?-3 q 7( -6 ' - For Local Agency to Complete: .-s Total Claimed DBE $ L9' Local Agency Contract Number: ,� L 5 Participation k ` Federal-aid Project Number: S�� \3 (014 (3s P-% Federal Share: Contract Award Date: Local Agency certifies that all DBE certifications have been verified and i ture of Bidde information is complete and accurate. 61.3r.Alt%Xi ate (Area Code)Tel.No. Print Name ignature / Date "— Local Agency Representative Person to Contact (Please Type or Print) Local Agency Bidder DBE Commitment(Construction Contracts) (Area Code)Telephone Number: 3 -9.14-52.1 S (Rev 6/26/09) Distribution: (1)Copy—Fax or scan a copy to the Caltrans District Local Assistance Engineer(DLAE)within 30 days of contract execution. Failure to send a copy to the DLAE within 30 days of contract execution may result in de-obligation of funds for this project. (2)Copy—Include in award package to Caltrans District Local Assistance (3) Original—Local agency files Page 15-31 OB 12-04 June 29,2012 Spc09-43 F-30 EXHIBIT 15-G Local Assistance Procedures Manual Local Agency Bidder DBE Commitment(Construction Contracts) INSTRUCTIONS-LOCAL AGENCY BIDDER DBE COMMITMENT(CONSTRUCTION CONTRACTS) ALL BIDDERS: PLEASE NOTE: This information may be submitted with your bid. If 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 the Special Provisions. Failure to submit the required DBE commitment will be grounds for finding the bid nonresponsive. The form requires specific information regarding the construction contract: Local Agency, Location, Project Description,Total Contract Amount,Bid Date, Bidder's Name, and Contract DBE Goal. The form has a column for the Contract Item Number and Item of Work and Description or Services to be Subcontracted or Materials to be provided by DBEs. Prime contractors shall indicate all work to be performed by DBEs including, if the prime is a DBE,work performed by its own forces, if a DBE. The DBE shall provide a certification number to the Contractor and expiration date. Enter the DBE prime's and subcontractors' certification numbers.The form has a column for the Names of DBE contractors to perform the work(who must be certified on the date bids are opened and include the DBE address and phone number). IMPORTANT: Identify all DBE firms participating in the project regardless of tier.Names of the First-Tier DBE Subcontractors and their respective item(s)of work listed should be consistent,where applicable, with the names and items of work in the "List of Subcontractors" submitted with your bid. There is a column for the DBE participation dollar amount. Enter the Total Claimed DBE Participation dollars and percentage amount of items of work submitted with your bid pursuant to the Special Provisions. (If 100%of item is not to be performed or furnished by the DBE, describe exact portion of time to be performed or furnished by the DBE.) See Section "Disadvantaged Business Enterprise(DBE),"of the Special Provisions(construction contracts),to determine how to count the participation of DBE firms. Exhibit 15-G must be signed and dated by the person bidding. Also list a phone number in the space provided and print the name of the person to contact. Local agencies should complete the Local Agency Contract Award, Federal-aid Project Number, Federal Share, Contract Award Date fields and verify that all information is complete and accurate before signing and filing. Page 15-32 June 29,2012 OB 12-04 Spc09-43 F-31 Local Assistance Procedures Manual Exhibit 15-H DBE Information-Good Faith Effort DBE INFORMATION- GOOD FAITH EFFORTS Federal-aid Project No. HSIPL-5413(014) Bid Opening Date The City of Rancho Palos Verdes established a Disadvantaged Business Enterprise(DBE)goal of 6%for this project. The information provided herein shows that a good faith effort was made. Lowest, second lowest and third lowest bidders shall submit the following information to document adequate good faith efforts. Bidders should submit the following information even if the"Local Agency Bidder DBE Commitment" form indicates that the bidder has met the DBE goal. This will protect the bidder's eligibility for award of the contract if the administering agency determines that the bidder failed to meet the goal for various reasons,e.g.,a DBE firm was not certified at bid opening, or the bidder made a mathematical error. Submittal of only the"Local Agency Bidder DBE Commitment" form may not provide sufficient documentation to demonstrate that adequate good faith efforts were made. The following items are listed in the Section entitled"Submission of DBE Commitment"of the Special Provisions: 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 Solicited Date of Initial Follow Up Methods and Dates Solicitation Page 15-33 June 29,2012 Spc09-43 F-32 Exhibit 15-H Local Assistance Procedures Manual DBE Information-Good Faith Effort C. The items of work which the bidder made available to DBE 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 firms. Items of Work Bidder Normally Breakdown of Amount Percentage Performs Item Items ($) Of (YIN) Contract D. The names, addresses and phone numbers of rejected DBE firms, the reasons for the bidder's rejection of the DBEs, the firms selected for that work(please attach copies of quotes from the firms involved), and the price difference for each DBE if the selected firm is not a DBE: Names, addresses and phone numbers of rejected DBEs and the reasons for the bidder's rejection of the DBEs: Names, addresses and phone numbers of firms selected for the 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 requirements for the work which was provided to DBEs: Page 15-34 June 29,2012 OB 12-04 Spc09-43 F-33 Local Assistance Procedures Manual Exhibit 15-H DBE Information-Good Faith Effort F. Efforts made to assist interested DBEs in obtaining necessary 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 Agency/Organization Method/Date of Contact Results H. Any additional data to support a demonstration of good faith efforts (use additional sheets if necessary): NOTE: USE ADDITIONAL SHEETS OF PAPER IF NECESSARY. 1 Page 15-34a OB 12-04 June 29,2012 Spc09-43 F-34 Local Assistance Procedures Manual EXHIBIT 16-Z Monthly DBE Trucking Verification STATE OF CALIFORNIA•DEPARTMENT OF TRANSPORTATION MONTHLY DBE TRUCKING VERIFICATION CP-CEM 2404(F)(NEW 12/1999) CONTRACT NO. MONTH YEAR DBE Company California Hwy Commission or Date Lease Arrangement Truck Owner Cert No. Name and Address Truck No. Patrol CA No. Amount Paid Paid (1 if applicable) Lease Agreement ❑ $ with Non-DBE ❑ with DBE 0 Lease Agreement ❑ $ with Non-DBE 0 with DBE ❑ Lease Agreement 0 $ with Non-DBE ❑ with DBE 0 Lease Agreement ❑ $ with Non-DBE ❑ with DBE ❑ Lease Agreement ❑ $ with Non-DBE 0 with DBE ❑ Lease Agreement 0 $ with Non-DBE 0 with DBE ❑ Lease Agreement ❑ $ with Non-DBE ❑ with DBE ❑ Lease Agreement 0 $ with Non-DBE 0 with DBE ❑ Lease Agreement ❑ $ with Non-DBE ❑ with DBE 0 Lease Agreement ❑ $ with Non-DBE 0 with DBE ❑ Lease Agreement ❑ $ with Non-DBE ❑ with DBE ❑ Lease Agreement ❑ $ with Non-DBE ❑ with DBE ❑ TOTAL AMOUNT PAID$ PRIME CONTRACTOR BUSINESS ADDRESS BUSINESS PHONE NUMBER *Upon request.all Lease Agreements.shall he made available,in accordance with the Special Provisions. I CERTIFY THAT THE ABOVE INFORMATION IS COMPLETE AND CORRECT. CONTRACTOR REPRESENTATIVE'S SIGNATURE TITLE DATE CEM-2404F(NEW 12/99) COPY DISTRIBUTION:ORIGINAL-RESIDENT ENGINEER Page 16-117 LPP 04-07 August 12,2004 Spc09-43 F-35 STATE OF CALIFORNIA•DEPARTMENT OF TRANSPORTATION MONTHLY DBE TRUCKING VERIFICATION CP-CEM 2404(F)(NEW 12/1999) The top of Form CEM-2404(F) contains boxes to put in the Contract Number, the Month of the reporting period, and the Year of the reporting period. Form CEM-2404(F) has a column to enter the name of the Truck Owner, the DBE Cert. No. (if DBE certified), and the Name and Address of the trucking company. Form CEM-2404(F) also requires the Truck No. and the California Highway Patrol CA No. Form CEM-2404(F) is to be submitted prior to the 15th of each month and must show the dollar amount paid to the DBE trucking company/companies for work performed by DBE certified trucks and for any fees or commissions of non-DBE trucks utilized each month on the project. The amount paid to each trucking company is to be entered in the column called"Commission or Amount Paid,"in accordance with the following: 1. 100%for the trucking services provided by the DBE using trucks it owns, operates, and insures. 2. 100% for the trucking services provided by trucks leased from other DBE firms. 3. The fee or commission paid on non-DBEs for the lease of trucks. The prime does not receive 100% credit for these services because they are not provided by a DBE company. The total dollar figure of this column is to be placed in the box labeled "Total Amount Paid." The column "Date Paid" requires the date that each trucking company is paid for services rendered. The next column contains information that must be completed if a lease arrangement is applicable. At the bottom of Form CEM 2404(F) is a space to put the name of the Prime Contractor, its Business Address, and its Business Phone No. At the bottom of the form is a space for the Contractor or designee ("Contractor Representative") Signature, Title, and Date, certifying that the information provided on the form is complete and correct. Page 16-118 LPP 04-07 August 12,2004 Spc09-43 F-36 Local Assistance Procedures Manual EXHIBIT 17-F Final Report-Utilization of Disadvantaged Business Enterprises(DBE), First-Tier Subcontractors STATE OF CALIFORNIA-DEPARTMENT OF TRANSPORTATION FINAL REPORT-UTILIZATION OF DISADVANTAGED BUSINESS ENTERPRISES ADA Notice (DBE), FIRST-TIER SUBCONTRACTORS For individuals with sensory disabilities,this document is available in alternate formats.For information call(916)654-6410 or TDD(916)654-3880 or write Records and Forms Management,1120 N Street,MS-89,Sacramento,CA 95814 CEM-2402F(REV 02/2008) CONTRACT NUMBER COUNTY ROUTE POST MILES FEDERAL AID PROJECT NO. ADMINISTERING AGENCY CONTRACT COMPLETION DATE LA HSIPL-5413(014) City of Rancho Palos Verdes PRIME CONTRACTOR BUSINESS ADDRESS ESTIMATED CONTRACT AMOUNT CONTRACT PAYMENTS ITEM DESCRIPTION OF WORK PERFORMED COMPANY NAME AND BUSINESS DATE WORK DATE OF NO. AND MATERIAL PROVIDED ADDRESS DBE CERT.NUMBER NON-DBE DBE COMPLETE FINAL PAYMENT $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ORIGINAL COMMITMENT $ TOTAL $ $ DBE List all First-Tier Subcontractors,Disadvantaged Business Enterprises(DBEs)regardless of tier,whether or not the firms were originally listed for goal credit. B actual DBE utilization(or item of work)was different than that approved at time of award,provide comments on back of form.List actual amount paid to each entity. I CERTIFY THAT THE ABOVE INFORMATION IS COMPLETE AND CORRECT CONTRACTOR REPRESENTATIVE'S SIGNATURE BUSINESS PHONE NUMBER DATE TO THE BEST OF MY INFORMATION AND BELIEF,THE ABOVE INFORMATION IS COMPLETE AND CORRECT RESIDENT ENGINEER'S SIGNATURE BUSINESS PHONE NUMBER DATE Copy Distribution-Caltrans contracts: Original-District Construction Copy-Business Enterprise Program Copy-Contractor Copy Resident Engineer Copy Distribution-Local Agency contracts: Original-District Local Assistance Engineer Copy-District Local Assistance Engineer Copy-Local Agency file (submitted with the Report of Expenditures) Page 17-21 LPP 09-02 July 31,2009 Spc09-43 F-37 Local Assistance Procedures Manual EXHIBIT 17-F Final Report-Utilization of Disadvantaged Business Enterprises(DBE),First-Tier Subcontractors FINAL REPORT—UTILIZATION OF DISADVANTAGED BUSINESS ENTERPRISES(DBE),FIRST-TIER SUBCONTRACTORS CEM 2402(F)(Rev.02/2008) The form requires specific information regarding the construction project: Contract Number,County,Route,Post Miles, Federal-aid Project No.,the Administering Agency,the Contract Completion Date and the Estimated Contract Amount. It requires the prime contractor name and business address. The focus of the form is to describe who did what by contract item number and descriptions,asking for specific dollar values of item work completed broken down by subcontractors who performed the work both DBE and non-DBE work forces. DBE prime contractors are required to show the date of work performed by their own forces along with the corresponding dollar value of work. The form has a column to enter the Contract Item No. (or Item No's)and description of work performed or materials provided, as well as a column for the subcontractor name and business address. For those firms who are DBE, there is a column to enter their DBE Certification Number. The DBE should provide their certification number to the contractor and not)the contractor in writing with the date of the decertification if their status should change during the course of the project. The form has two columns for the dollar value to be entered for the item work performed by the subcontractor. The Non-DBE column is used to enter the dollar value of work performed for firms who are not certified DBE. The decision of which column to be used for entering the DBE dollar value is based on what program(s)status the firm is certified. This program status is determined by the California Unified Certification Program by ethnicity,gender, ownership,and control issues at time of certification. To confirm the certification status and program status,access the Department of Transportation Civil Rights web site at:http://www.dot.ca.gov/hq/bep or by calling(916)324-1700 or the toll free number at(888) 810-6346. Based on this DBE Program status,the following table depicts which column to be used: DBE Program Status Column to be used If program status shows DBE only with no other programs listed DBE If a contractor performing work as a DBE on the project becomes decertified and still performs work after their decertification date,enter the total dollar value performed by this contractor under the appropriate DBE identification column. If a contractor performing work as a non-DBE on the project becomes certified as a DBE, enter the dollar value of all work performed after certification as a DBE under the appropriate identification column. Enter the total of each of the two columns in Form CEM-2402(F). Any changes to DBE certification must be submitted on Form-CEM 2403(F). Enter the Date Work Completed as well as the Date of Final Payment(the date when the prime contractor made the 'final payment"to the subcontractor for the portion of work listed as being completed). The contractor and the resident engineer sign and date the form indicating that the information provided is complete and correct. Page 17-22 July 31,2009 LPP 09-02 Spc09-43 F-38 Local Assistance Procedures Manual EXHIBIT 17-0 Disadvantaged Business Enterprises(DBE)Certification Status STATE OF CALIFORNIA—DEPARTMENT OF TRANSPORTATION DISADVANTAGED BUSINESS ENTERPRISES(DBE)CERTIFICATION STATUS CHANGE CP-CEM-2403(F) (New. 10/99) CONTACT NUMBER COUNTY ROUTE POST MILES ADMINISTERING AGENCY CONTRACT COMPETION DATE HSIPL-5413(014) LA City of Rancho Palos Verdes PRIME CONTRACTOR BUSINESS ADDRESS ESTIMATED CONTRACT AMOUNT Prime Contractor:List all DBEs with changes in certification status(certified/decertified)while in your employ,whether or not firms were originally listed for good credit. Attach DBE certification/Decertification letter in accordance with the Special Provisions CERTIFICATION/ CONTRACT SUBCONTRACT NAME AND BUSINESS CERTIFICATION NUMBER AMOUNT PAID WHILE DECERTIFICATION ITEM NO. BUSINESS ADDRESS PHONE CERTIFIED DATE Letter attached $ i Comments: I CERTIFY THAT THE ABOVE INFORMATION IS COMPLETE AND CORRECT CONTRACTOR REPRESENTATIVE SIGNATURE TITLE BUSINESS PHONE NUMBER DATE TO THE BEST OF MY KNOWLEDGE, THE ABOVE INFORMATION IS COMPLETE AND CORRECT RESIDENT ENGINEER BUSINESS PHONE NUMBER DATE DISTRIBUTION Original copy-DLAE Copy-I)Business Enterprise Program 2)Prime Contactor 3)Local Agency 4)Resident Engineer Page 17-43 LPP 06-03 July 21,2006 Spc09-43 F-39 EXHIBIT 17-0 Local Assistance Procedures Manual Disadvantaged Business Enterprises(DBE)Certification Status Change Form CP-CEM 2403(F) (New 10/99) DISADVANTAGED BUSINESS ENTERPRISES (DBE)CHANGE IN CERTIFICATION STATUS REPORT The top of the form requires specific information regarding the construction project: Contract Number, County, Route,Post Miles, the Administering Agency, the Contract Completion Date, and the Estimated Contract Amount. It requires the Prime Contractor's name and Business Address. The focus of the form is to substantiate and verify the actual DBE dollar amount paid to contractors on federally funded projects that had a changed in Certification status during the course of the completion of the contract. The two situations that are being addressed by CP-CEM 2403(F)are, if a firm certified as a DBE and doing work on the contract during the course of the project becomes Decertified, and if a non-DBE firm doing work on the contract during the course of the project becomes Certified as a DBE. The form has a column to enter the Contract Item No(or Item Nos.)as well as a column for the Subcontractor's Name, Business Address, Business Phone,and contractor's Certification Number. The column entitled Amount Paid While Certified will be used to enter the actual dollar value of the work performed by those contractors who meet the conditions as outlined above during the time period they are Certified as a DBE. This column on the CP-CEM-2403(F) should only reflect the dollar value of work performed while the firm was Certified as a DBE. The column called Certification/Decertification Date(Letter attached)will reflect either the date of the Decertification Letter sent out by the Civil Rights Program or the date of the Certification Certificate mailed out by the Civil Rights Program. There is a box to check that support documentation is attached to the CP-CEM- 2403 (F) form. There is a Comments section for any additional information that may need to be provided regarding any of the above transactions. The CEM-2403(F)has an area at the bottom where the Contractor and the Resident Engineer sign and date that the information provided is complete and correct. There is a Comments section for any additional information that may need to be provided regarding any of the above transactions. The CEM-2403(F)has an area at the bottom where the Contractor and the Resident Engineer sign and date that the information provided is complete and correct. Page 17-44 July 21,2006 LPP 06-03 Spc09-43 F-40 CITY OF RANCHO PALOS VERDES BIDDER INFORMATION SHEET Project/Contract No.: HSIPL-5413(014) Bid Opening Date: //3-0/90/ Project Title: Hawthorne Boulevard Signal Synchronization Proiect DBE Goal for Contract (if any): 6% The following information is requested for all contractors who provide a bid, proposal, or quote, or who are contacted by the proposed prime contractor. This information should be submitted with your bid, proposal, or quote. If you are the apparent low bidder (or the second or third low bidder), the information should be submitted within four businessdaysof the bid opening date. Information provided will be held in confidence. Firm Name: Tf-e2 Address: /a57 /U . Contractor's License Number and Class: 13�� —(0 Telephone: -2/6(-- 44'f 7- 0173'.00 Facsimile: 77c1-16—D1 Years in Business: (215— Is the firm currently ecrtificd as a DBE? s 0 No - If yes, indicate certification status: 0 Black American 0 an-Pacific Islander ❑ Native American oman ❑ Hispanic American 0 Sub-continent Asian American and DBE Certification No.: Nlll- r Contract items or description of work: � fifi'/G / -A�o ti Dollar Amount of items bid on (this contract): Gross Annual Receipts (last year):* ❑ Lselhan $1 million 1 million - $5 million ❑ $5 million - $10 million ❑ $10 million-$15 million ❑ Over$15 million (Please duplicate this form and provide information on all bidders.) THE CITY OF RANCHO PALOS VERDES THANKS YOU FOR YOUR ASSISTANCE. *This information is requested pursuant to Federal law. Spc09-43 F-41 PROPOSAL CITY OF RANCHO PALOS VERDES HAWTHORNE BOULEVARD SIGNAL SYNCHRONIZATION PROJECT FEDERAL PROJECT NO.HSIPL-5413(014) TO THE CITY COUNCIL OF THF CITY OF RANCHO PALOS VERDES The undersigned, as bidder, declares that: (1) this proposal is made without collusion with any other person, firm or corporation, and that the only persons or parties interested as principals are those named herein; (2) bidder has carefully examined the project plans, specifications, instructions to bidders, proposal, notice to contractors and all other information furnished therefore and the site of the proposed work; (3) bidder has investigated and is satisfied as to the conditions to be encountered, the character, quality and quantities of work to be performed and materials to be furnished. Furthermore,bidder agrees that submission of this proposal shall be conclusive evidence that such examination and investigation have been made and agrees, in the event this contract be awarded to bidder,to enter into a contract with the CITY COUNCIL of the CITY OF RANCHO PALOS VERDES, to perform said proposed work in accordance with the plans, if any, and the terms of the specifications, in the time and manner therein prescribed, and to furnish or provide all materials, labor, tools, equipment, apparatus and other means necessary so to do,except such thereof as may otherwise be furnished or provided under the terms of said specifications, for the following stated unit prices or lump-sum price as submitted on the Schedule attached hereto: The bidder shall submit as part of this proposal a completed copy of the Contractor's Industrial Safety Record. Accompanying this proposal is Bid Bond (Insert"$ cash," "Cashier's Check," "certified check," or"Bid Bond," as the case may be)in the amount equal to at least ten percent(10%)of the total aggregate bid price hereof based on the quantities shown and the unit prices quoted in the Bid Sheets. The undersigned further agrees that should he/she be awarded the contract on the basis hereof and thereafter, defaults in executing the required contract, with necessary bonds and documents, within ten (10) days, not including Sundays and legal holidays, after having received notice that the contract has been awarded and is ready for signature,the proceeds of the security accompanying his bid shall become the property of the CITY OF RANCHO PALOS VERDES and this proposal and the acceptance thereof may be considered null and void. Licensed in accordance with an act providing for the registration of contractors, California Contractor's License No. 731356 ,Class C=1 q Expiration Date 1/31/2017 Department of Industrial Relations(DIR)Registrati n Na. 100001:•1, Signature(s)of bidder: 144't. If an individual, so state. If a firm or co-partnership, state the firm name and give the names of all individual co-partners composing the firm. If a corporation, state legal name of corporation, also names of president, secretary, treasurer, and manager thereof. Two notarized officer's signatures and the corporate seal are required for corporations. Spc09-43 P-1 Legal Business Name: Pro Tech Engineering Coro Address: 1051 N jPatt StreeetAnaheim CA 92801 Telephone:(714)446-0800 Contact: Mike Niknafs Proposals which do not show the number and date of the Bidder's License under the provisions of Chapter 9 of Division 3 of the Business&Professional Code will be rejected. Spc09-43 P-2 BID SCHEDULE INCLUDES ALL WORK TO BE DONE ON CITY OF RANCHO PALOS VERDES HAWTHORNE BOULEVARD SIGNAL SYNCHRONIZATION PROJECT FEDERAL PROJECT NO.HSIPL-5413 (014) IN THE CITY OF RANCHO PALOS VERDES BID SHEET NAME OF COMPANY:.Pro Tech Engineering Corp To the Honorable Mayor and Members of the City Council: In compliance with the Notice Inviting Sealed Bids,the undersigned hereby agrees to enter into a contract to furnish all labor, materials, equipment and supplies for the project identified as HAWTHORNE BOULEVARD SIGNAL SYNCHRONIZATION PROJECT, FEDERAL PROJECT NO. HSIPI.- 5413(014)in accordance with the specifications and plans in the Contract Documents which are on file in the office of the Director of Public Works of the City of Rancho Palos Verdes to the satisfaction and under the direction of the Director of Public Works at the following prices: HAWTHORNE BOULEVARD SIGNAL SYNCHRONIZATION PROJECT FEDERAL PROJECT NO.HSIPL-5413(014) Base Bid Items for Hawthorne Boulevard Improvements ITEM ESTIMATED PRICE EXTENDED NO. DESCRIPTION QUANTITY UNIT UNIT AMOUNT 1. Mobilization, Noise Control, 1 LS $30,000 $30,000 Cleanup and Dust Control 2. Traffic Control Plan and80 Per $100 $8,000 Implementation Day 3. Pothole of All Utilities Within the Work Zone Prior To Start of 1 LS $20,000 $20,000 Work and Placing Conduit 4. Install 48 Strand SMFO Cable. 23,195 LF $1 $23,195 (Owner to furnish Cable.) 5. Install 6 Strand SMFO Drop 1,155 LF $1 $1,155 Cable.(Owner to furnish Cable.) 6. Furnish and Install #10 Green 21,015 LF $.85 $17,862.75 Trace Wire 7. Furnish and Install 2"Conduit 21,015 LF $21 $441,315 8. Furnish and Install 3"Conduit 80 LF $75 $6,000 Spc09-43 P-3 ITEM DESCRIPTION ESTIMATED UNIT PRICE EXTENDED NO. QUANTITY UNIT AMOUNT 9. Furnish and Install Fiber Patch Panel (FPP) and complete 7 EA $900 $6,300 connections to a 6 SMFO drop cable 10. Furnish and Install Splice Closure , 7 EA $850 $5,950 11, Fusion splice two strands of drop 7 EA $325 $2,275 cable to Mainline cable W 12. Furnish and Install 6E Pull Box 9 EA $850 $7,650 13. Furnish and Install#6 Pull Box 32 EA $750 $24,000 14. Remove and Salvage Existing Cabinet. Furnish and Install 332 Controller Cabinet on New 2 EA $20,750 $41,500 Foundation. Provide temporary signal operation during changeout. 15. Furnish and Install Countdown 24 EA $615 $14,750 Traffic Signal Pedestrian Heads 16. Furnish and Install Ethernet Switch for 170E Traffic 7 EA $2,000 $4,000 Controller 17. Furnish and Install Ethernet Module for 170E Traffic 7 EA $600 $4,200 Controller - 18. Furnish and Install Power Strip 7 EA $150 $1,050 19. Furnish and Install 96-port Fiber 1 EA $5,850 $5,850 Distribution Unit in existing Rack 20. Furnish and Install Aggregation 1 EA $3,750 $3,750 Switch 21. Furnish and Install Battery Back- $72,000 Up Units in new side-mount 6 EA $12,000 cabinet 22. Furnish and Install Battery Back- 1 EA $9,500 $9,500 Up Units for Traffic Controllers SUB-TOTAL $760,312.75 SUB-TOTAL AMOUNT FOR HAWTHORNS BLVD 1N WORDS FOR BID SC EDULE(ITEMS 1- 22): ,'..J'C1 c Wc�a,�c�. 4 .4. k1, ‘ lh00.'41411d LA.x..,c LAix.,vc,�K-rc( �...,ttJ Spc09-43 P-4 Base Bid Items for Ryan Park Fiber Optic Communication ITEMDESCRIPTION ESTIMATED UNIT ESTIMATED EXTENDED NO. QUANTITY _ UNIT AMOUNT 23. Install 12 Strand SMFO Drop 600 LF $1 $600 Cable.(Owner to furnish Cable.) 24. Furnish and Install #10 Green 410 LF $.85 $348.50 Trace Wire 25. Furnish and Install 2"Conduit 410 LF $22 $9,020 26. Furnish and Install 2" RGS 25 LF $55 $1,375 Conduit 27. Furnish and Install Fiber Patch Panel (FPP) and complete l EA $1,150 $1,150 connections to a 12 SMFO drop cable 28. Furnish and Install Splice 1 EA $850 $850 Enclosure 29. Fusion splice two strands of drop 1 EA $3500 $350 cable to Mainline cable 30. Furnish and Install#6 Pull Box 2 EA $750 $1,500 31. Core through wall/seal 1 EA -$250 $250 32. Furnish and Install Wall-Mounted 1 EA $1,250 $1,250 Enclosed 19"rack SUB-TOTAL $16,755 SUB-TOTAL AMOUNT FOR RYAN PARK IN NyORDS BID SCHEDULE(ITEMS 23-32): 41 u , .4.-d ii . ,�. J4i Spc09-43 P-5 Base Bid Items for Hesse Park Fiber Optic Communication ITEMDESCRIPTION ESTIMATED UNIT PRICE EXTENDED NO. QUANTITY UNIT AMOUNT 33. Install 12 Strand SMFO Drop 800 LF $1 $800 Cable.(Owner to furnish Cable.) 34. Furnish and Install #I0 Green 440 LF $.85 $375 Trace Wire 35. Furnish and Install 2"Conduit 440 LF $22 $9,680 36. Furnish and Install 2" RGS 35 LF $55 $1,925 Conduit 37. Furnish and Install Fiber Patch Panel (FPP)and complete connections to a 1 EA $1,000 $1,000 6 SMFO drop cable 38. Furnish and Install Splice 1 EA $850 $850 Enclosure 39. Fusion splice two strands of drop 1 EA $350 $350 cable to Mainline cable 40. Furnish and Install#6 Pull Box 2 EA $750 $1,500 41. Core through brick wall/seal 1 EA $250 $250 SUB-TOTAL $16,729 SUB-TOTAL AMOUNT FOR HESSE PARK IN WORDS FJOR BID SCHEDULE(ITEMS 33-41): TOTAL BASEJJBIDJ/ AMOUNT OF PROJECT IN WORDS FOR BID SCHEDULE(ITEMS 1-41):__ 5-mq iii /haat,„ " Ar+ ttrirt tict.is." 'At AV4i re Pl att 1 4;st �.vt/•�3 Spc09-43 P-6 *ALTERNATE BID ITEMS FOR HAWTHORNE BOULEVARD ITEM DESCRIPTION ESTIMATED UNIT PRICE EXTENDED NO. QUANTITY UNIT AMOUNT 42. Install 3" Conduit in Open Cut Trench with Grass/Dirt/Gravel 3,700 LF $35 $129,500 Cover 43. Install 3" Conduit in Open Cut Trench with 4" Sidewalk Cover. 300 LF $75 $22,500 (All sidewalk to be 3,250 PSI). 44, Install 3" Conduit in Open Cut Trench with 8" Conc. Spandrel 100 LF $125 $12,500 Cover, 45. Install 3" Conduit in Open Cut Trench with Asphalt Cover (4" 100 LF $85 $8,500 AC on 6"CMB) 46. Install 3" Conduit in Open Cut Trench with Asphalt Cover (12" 100 LF $95 $11,875 AC on 6"CMB) SUB-TOTAL $184,875 SUB-TOTAL AMOUNT FOR ALTERNATE BID ITEMS IN WORDS FOR BID SCHEDULE(ITEMS � t. 42-46): / l �„ Ic 6 t I/i,at'i/4 a 'c/ -fit /i�, rr�{ * TOTAL BASE BID PLUS BID ALTERNATE ITEMS AMOUNT OF PROJECT IN WORDS FOR BID SCHEDULE(ITEMS 146):_1978.671.75 * Notes for Alternate Bid Items: 1. These bid items(Bid Items 42-46)will be added to base bid amount and lowest total, inclusive of base bid items and alternate bid items(Bid Items 1-46),shall be utilized for awarding lowest total responsive/responsible bid contract amount. 2. Limits of open cut in dirt/grass/gravel(Bid Item 42)shall be applicable from street station 17+00 to 54+00.It shall be at contractor's discretion if open cut or horizontal directional drill(HDD)shall be used within these limits.The lowest lineal foot bid cost(open cut or HDD)shall be paid within these limits irrespective of installation method used. 3. Other limits of potential open cut alternate bid items shall be applicable if HDD is unsuccessful due to unforeseen rocks or other underground structures. Spc09-43 P-7 General Notes: 1. Contractor is advised that power duct bank conduit runs under the sidewalk and is in close proximity to the proposed conduit alignment from approx.street station 24+00 to 95+00. The contractor is required to locate the facility and is advised to exercise due caution during installation of proposed conduit. 2. Contractor is advised that gas,telephone and other utilities are in close proximity under the sidewalk within the proposed conduit alignment within various reaches of the project.The contractor is advised to locate the facilities and to exercise due caution during installation of proposed conduit. Spc09-43 P-8 INFORMATION REQUIRED OF BIDDER The bidder is required to supply the following information: (Additional sheets may be attached if necessary.) (1) Address: 1051 N. Patt Street Anaheim CA 92801 (2) Telephone: (714)446-0800 (3) Type of firm-Individual,Partnership,or Corporation: Corporation (4) Corporation organized under the laws of the State of California (5) Contractor's license number and class: 731356 ;C-10 (6) List the names and addresses of all members of the firm or names and titles of all officers of the corporation: Mike Niknafs, President Sohela Kaidi, Sec/Treas (7) Number of years experience as a contractor in construction work 25 (8) List at least three similar projects completed as of recent date: Contract Amount Class of Work Date Completed . Names Address of Owner,&Telephone No. $675,400 Fiber Optic&CCTV March 2015 Keith Carter,City of Cypress(714)229-0154 $295,350 Fiber Optic&CCN October 2015 Jose Castro,City of Brea (714)990-7761 $675.225 Fiber Optic&CCW January 9016 Rrad Si immprq City of Nwwpnrt(Q49)&14-3326 $478,500 Traffic Signal Mod. September 2015 Robert Palaeologus,City of Anaheim(714)765-5285 Spc09-43 P-9 (9) List the name and address of such subcontractor who will perform work in or about the work of improvement and indicate what part of the work will be done by each such contractor: NAME Crosstown Electrical&Data TYPE OF WORK Fiber Optic Splicing ADDRESS 5463 Diaz Street Irwindale. CA 91706 ✓.... C i .. NAME � TYPE OF WORK � .. ;J5 t'*d 0/2 �``' �t• 4/1-e, ! ADDRESS41° 4 da lil-Gam.--, et 9 o tioV NAME TYPE OF WORK ADDRESS NAME TYPE OF WORK ADDRESS (10) List the name of the person who inspected the site of the proposed work for your firm: Mike Vildosola (11) NOTE: Upon request of the Redevelopment Agency,the bidder shall furnish evidence showing a notarized financial statement,financial data,construction experience,or other information. (12) Bidder shall be properly licensed in accordance with Business and Professional Code Section 7028 at the time of the Business and Professional Code shall be considered non-responsive and his bid shall be rejected. (13) Within 24 hours of the bid opening, the apparent low bidder shall submit the following information for each subcontractor: Sub-Contractor Name Crosstown Electrical&Data �J License No.and Class 756309 DIR Registration No. t ede,,e)/S Verified with Contractor's State License Board&Department of Industrial Relations on 12/1/2015 by Mike Niknafs Title President Spc09-43 P-10 STATEMENT ACKNOWLEDGING PENAL AND CIVIL PENALTIES CONCERNING THE CONTRACTORS' LICENSING LAWS [Business&Professions Code 7028.151 [Public Contract Code 20103.51 I, the undersigned,certify that I am aware of the following provisions of California law and that 1, or the entity on whose behalf this certification is given, hold a currently valid California contractor's license as set forth below: Business&Professions Code 7028.15: (a) It is a misdemeanor for any person to submit a bid to a public agency in order to engage in the business or act in the capacity of a contractor within this state without having a license therefore,except in any of the following cases: (1) The person is particularly exempted from this chapter. (2) The bid is submitted on a state project governed by Section 10164 of the Public Contract Code or on any local agency project governed by Section 20104[now'20103.5]of the Public Contract Code. (b) If a person has been previously convicted of the offense described in this section, the court shall impose a fine of 20 percent of the price of the contract under which the unlicensed person performed contracting work, or four thousand five hundred dollars ($4,500), whichever is greater, or imprisonment in the county jail for not less than 10 days nor more than six months,or both. In the event the person performing the contracting work has agreed to furnish materials and labor on an hourly basis, "the price of the contract" for the purposes of this subdivision means the aggregate sum of the cost of materials and labor furnished and the cost of completing the work to be performed. (c) This section shall not apply to a joint venture license, as required by Section 7029.1. However, at the time of making a bid as a joint venture, each person submitting the bid shall be subject to this section with respect to his or her individual licensure. (d) This section shall not affect the right or ability of a licensed architect, land surveyor,or registered professional engineer to form joint ventures with licensed contractor to render services within the scope of their respective practices. (e) Unless one of the foregoing exceptions applies, a bid submitted to a public agency by a contractor who is not licensed in accordance with this chapter shall be considered non- responsive and shall be rejected by the public agency. Unless one of the foregoing exceptions applies, a local public agency shall, before awarding a contract or issuing a purchase order, verify that the contractor was properly licensed when the contractor submitted the bid. Notwithstanding any other provision of law, unless one of the foregoing exceptions applies, the registrar may issue a citation to any public officer or employee of a public entity who knowingly awards a contract or issues a purchase order to a contractor who is not licensed pursuant to this chapter. The amount of civil penalties, appeal, and finality of such citations shall be subject to Sections 7028.7 to 7028.13 inclusive. Any contract awarded to, or any purchase order issued to, a contractor who is not licensed pursuant to this chapter is void. Spc09-43 P-11 (f) Any compliance or noncompliance with subdivision (e) of this section, as added by Chapter 863 of the Statutes of 1989,shall not invalidate any contract or bid awarded by a public agency during which time that subdivision was in effect. (g) A public employee or officer shall not be subject to a citation pursuant to this section if the public employee, officer, or employing agency made an inquiry to the board for the purposes of verifying the license status of any person or contractor and the board failed to respond to the inquiry within three business days. For purposes of this section, a telephone response by the board shall be deemed sufficient. Public Contract Code 20103.5.- In all contracts subject to this part where federal funds are involved, no bid submitted shall be invalidated by the failure of the bidder to be licensed in accordance with the laws of this state. However, at the time the contract is awarded, the contractor shall be properly licensed in accordance with the laws of this state. The first payment for work or material under any contract shall not be made unless and until the Registrar of Contractors verifies to the agency that the records of the Contractor's State License Board indicate that the contractor was properly licensed at the time the contract was awarded. Any bidder or contractor not so licensed shall be subject to all legal penalties imposed by law including, but not limited to, any appropriate disciplinary action by the Contractor's State License Board. The agency shall include a statement to that effect in the standard form of prequalification questionnaire and financial statement. Failure of the bidder to obtain proper and adequate licensing for an award of a contract shall constitute a failure to execute the contract and shall result in the forfeiture of the security of the bidder. License No.: 731356 Class: C-10 Expiration Date: 1/31/2017 Date: 12/1/2015 ) Signature: N !IrG' Spc09-43 P-12 CONTRACTOR'S INDUSTRIAL SAFETY RECORD Record Last Five(5)Full Years: Year of Record 2010 2011 2012 2013 2014 Total Current Year 29 6 5 7 6 5 29 6 1. No.of contracts 2. Total dollar amount of contracts(in thou- 14.69 2.6 2.85 3.73 2.65 2.86 14.69 3.25 sands of$) *3. No.of fatalities 0 0 0 0 0 0 0 0 *4. No.of lost workday cases 0 0 0 0 0 0 0 0 *5. No.of lost workday cases involving per- manent transfer to another job or termi- 0 0 0 0 0 0 0 0 nation of employment The information required for these items is the same as required for Columns 3 to 6,Code 10,Occupational Injuries,Summary-Occupational Injuries and Illnesses No.102. The above information was compiled from the records that are available to me at this time,and I declare under penalty of perju that tke information is true and accurate within the limitations of those records. �` pro Tech Engineering Corp /1";,,,/ _/' M Name of Bidder(print) Si tup 1051 N. Patt Street 731357 ; C-10 Address State Contractor's Lic.#&Classification Anaheim,CA 92801 (714)446-0800 City Zip Code Telephone Spc09-43 P-13 Bond No. BID BOND KNOW ALL PERSONS BY THESE PRESENTS that: WHEREAS the ("Public Agency"), has issued an invitation for bids for the work described as follows: HAWTHORNE BOULEVARD SIGNAL SYNCHRONIZATION PROJECT - FEDERAL PROJECT NO.HSIPL-5413(014) WHEREAS (Name and address of Bidder) ("Principal"),desires to submit a bid to Public Agency for the work. WHEREAS,bidders are required under the provisions of the California Public Contract Code to furnish a form of bidder's security with their bid. NOW,THEREFORE,we,the undersigned Principal, and (Name and address of Surety) ("Surety") a duly admitted surety insurer under the laws of the State of California,as Surety, are held and firmly bound unto the Public Agency in the penal sum of Dollars($ ), being not less than ten percent (10%) of the total bid price,in lawful money of the United States of America,for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally,firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH THAT, if the hereby bounded Principal is awarded a contract for the work by the Public Agency and,within the time and in the manner required by the bidding specifications, enters into the written form of contract included with bidding specifications, furnishes the required bonds, one to guarantee faithful performance and the other to guarantee payment for labor and materials,and furnishes the required insurance coverages,then this obligation shall become null and void;otherwise,it shall be and remain in full force and effect. In case suit is brought upon this bond, Surety further agrees to pay all court costs incurred by the Public Agency in the suit and reasonable attorneys'fees in an amount fixed by the court. Surety hereby waives the provisions of California Civil Code'2845. Spc09-43 P-14 IN WITNESS WHEREOF, this instrument has been duly executed by Principal and Surety, on the date set forth below,the name of each corporate party being hereto affixed and these presents duly signed by its undersigned representative(s)pursuant to authority of its governing body. Dated: "Principal" "Surety" By: By: Its Its By: By: Its Its (Seal) (Seep Note: This bond must be dated,all signatures must be notarized,and evidence of the authority of any person signing as attorney-in- fact must be attached. Spc09-43 P-15 NONCOLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID [Public Contract Code 7106] State of California ))ss. County of Orange ) Mike Niknafs , being first duly sworn, deposes and says that he or she is President of Pro Tech Engineering Corp the party making the foregoing bid, that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham;that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid,and has not directly or indirectly colluded,conspired,connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit,or cost element of the bid price, or of that of any other bidder,or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further,that the bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization,bid depository,or to any member or agent thereo effectuate *t u sive✓or sham bid. //' � Signature 12/1/2015 (Late) State of California County of Orange 1 Subscribed and sworn to(or affirmed)before me on this 1st day of December ,2015, by Mike Niknafs ,proved to me on the basis of satisfactory evid ce to be the person(s)who appeared before me. WG' " ~`'` `t-` r p ; i ;;6 Notary Public California- Signature zs. At `. ^-,y"' Orange County �_ '°"� My Comm.Expires Jun 20,2017 ;(seal) Spc09-43 P-16 Bond No. ERCA941700232 PAYMENT BOND Executed in duplicate (LABOR AND MATERIALS) Premium Listed on Performance Bond KNOW ALL PERSONS BY THESE PRESENTS that: WHEREAS the City of Rancho Palos Verdes ("Public Agency"),has awarded to Pro Tech Engineering Corporation dba Pro Tech Electric 1051 N. Patt Street, Anaheim, CA 92801 (Name and address of Contractor) ("Principal"), a contract (the "Contract") for the work described as follows: HAWTHORNE BLVD SIGNAL SYNCHRONIZATION PROJECT,FEDERAL PROJECT NO.HSIPL-5413(014) WHEREAS,Principal is required under the terms of the Contract and the California Civil Code to secure the payment of claims of laborers,mechanics,materialmen,and other persons as provided by law. NOW,THEREFORE,we,the undersigned Principal,and Endurance Reinsurance Corporation of America 4 Manhattanville Road, Purchase, NY 10577 (Name and address of Surety) ("Surety") a duly admitted surety insurer under the laws of the State of California, as Surety, are held and firmly bound unto the Public Agency in the penal sum of Seven Hundred Sixty Thousand Three Hundred Seventy Two& 75/100 -- Dollars($760,372.75 ), this amount being not less than one hundred percent (100%) of the total contract price, in lawful money of the United States of America, for the payment of which sum well and truly to be made,we bind ourselves,our heirs, executors,administrators, successors,and assigns,jointly and severally,firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH THAT,if the hereby bounded Principal,his,her or its heirs, executors, administrators, successors or assigns, or subcontractors shall fail to pay any of the persons named in Section 3181 of the California Civil Code,or any amounts due under the Unemployment Insurance Code with respect to work or labor performed under the Contract,or for any amounts required to be deducted, withheld, and paid over to the Employment Development Department from the wages of employees of the Principal and subcontractors pursuant to Section 13020 of the Unemployment Insurance Code, with respect to work or labor performed under the Contract,the Surety will pay for the same in an amount not exceeding the penal sum specified in this bond;otherwise,this obligation shall become null and void. This bond shall inure to the benefit of any of the persons named in Section 3181 of the California Civil Code so as to give a right of action to such persons or their assigns in any suit brought upon the bond. In case suit is brought upon this bond, Surety further agrees to pay all court costs and reasonable attorneys' fees in an amount fixed by the court. Further, the Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration,addition or modification to the terms of the Contract,or of the work to be performed thereunder, or the specifications for the same,shall in any way affect its obligations under this bond,and it does hereby waive notice of any such change,extension of time,alteration,addition,or modification to the terms of the Contract or to the work or to the specifications thereunder. Surety hereby waives the provisions of California Civil Code'2845 and 2849. Spc09-43 IN WITNESS WHEREOF, two (2) identical counterparts of this instrument, each of which shall for all purposes be deemed an original hereof, have been duly executed by Principal and Surety,on the date set forth below,the name of each corporate party being hereto affixed and these presents duly signed by its undersigned representative(s)pursuant to authority of its governing body. Dated: April 25th, 2016 "Principal" "Surety" Pro Tech Engineering Corporation Endurance Reinsurance Corporation dba Pro Tech Electric of America • By: By: At ILI& I Its StephanieH•- g, Attorney-in-Fact By: By: 11111/ Its Its (Seal) (Seal) APPROVED AS TO SURETY AND APPROVED AS TO FORM: PRINCIPAL AMOUNT ALESIURE&WYNDER,LLP A Professional Corporation By: By: Insurance Administrator Public Agency Attorney Note: This bond must be executed in duplicate and dated,all signatures must be notarized,and evidence of the authority of any person signing as attorney-in-fact must be attached. Spc09-43 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT 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 truthfulness,accuracy,or validity of that document. State of California ) County of Orange ) On /,2-'S//f 0 before me, Barbara Copeland ,Notary Public, personally appeared Stephanie Hoang Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s)acted,executed the instrument. I certify under PENALTY OF PERJURY under the BARBARA OPELAND laws of the State of California that the foregoing Commission #2016348 paragraph is true and correct. , Notary Public-California z z ''` '' Orange County M/ WITNESS m hand and official seal.Comm.E iVres Apr 19.2017 y.t' g Si nature: /--- .14-ist C�� Signature ofNotPublic Place Notary Seal Above OPTIONAL --- — --- Though the information below is not required by law,it may prove valuable to persons relying on the document and could present fraudulent and reattachment of this form to another document. Description of Attached Document Type or Title of Document: Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Capacity(ies)Claimed by Signer(s) Signer's Name: Stephanie Hoang Signer's Name: El Individual ❑ Individual ❑ Corporate Officer–Title(s): ❑ Corporate Officer–Title(s): El Partner: ['Limited ❑ General El Partner: ['Limited ❑General ® Attorney in Fact ❑ Attorney in Fact ❑ Trustee ❑ Trustee ❑ Guardian or Conservator ❑ Guardian or Conservator ❑ Other: ❑ Other: Signer Is Representing: Signer Is Representing: Rev. 1-15 ENDURANCE REINSURANCE CORPORATION OF AMERICA POWER OF ATTORNEY ERCA941700232 RJpow aft-Men 6y these , that ENDURANCE REINSURANCE CORPORATICN OF AMERICA,a Delaware corporation(the'Corporatiort1,with offices at 4 Manhattanville Road,3rd Floor,Purchase,NW 10577,has made,constituted and appointed and by these presents,does make,constitute and appoint ERIC LOWEY,MARK RICHARDSON,SHAWN BLUME,STEPHANIE HOANG its true and lawful Attomey(s)-in-fact,at COSTA MESA in the Stale of CA and each of them to have full power to act without the other or others,to make,execute and deliver on its behalf,as surety or co-surety,bonds and undertakings given for any and all purposes,also to execute and deliver cn its behalf as aforesaid renewals,extensions,agreements,waivers,consents or stipulations relating to such bonds or undertakings provided,however,that no singe bond or undertaking so math,executed and delivered shall obligate the Corporation for any portion of the penal sum thereof in excess of the sum of SEVEN MILLION FIVE HUNDRED TI-(QUSAND Dollars($7,500,000) Such bon¢ `ityn�LsrlakirxgsT Oirposes,when duly executed by said allorney(s)-in-fact,shall be binding upon the Corporation as fully and to the same extent as if signed by the Fresh( Tth r eri(s 6rporate seal attested by its Corporate Secrelay. ThisAegititrpt made ander au M rrfy of cedan resolutions adopted by the Board of Directors of the Corporation by unanimous written consent on the9th of January,2014, a crgi( which appears below under the he*iricg entitled'Certificate'. Thg awer of Attorr ay' rid sealed'bpecsirnile under and by authority of the following resolution adopted by the Board of Directors of the Corporation by unan mous written con pt on January 9 1¢ 1 said resolutioicl'has not sirue been revoked,amended or repealed. RES, IED,that in granting powers of attorney pursuant to certain resolutions adopted by the Board of Directors of the Corporation by unanimous written consent on January9,2014, the sag lyre h directors arers*Ared'the seal of the Corporation may be affixed to any such power of attorney or any certificate relating thereto by facsimile,and any such power'sf n'W. ryiicka a�leaeifrg S'ftcsimile signature or seal shall be valid and binding upon the Corporation in the future with respect to any bond or undertaking to which it sattach ° • "w v{ ",a • This Power of Atllorgeysha l eypire.and all authority hereunder shall terminate without notice at midnight(Standard Timer where said attomey(s)-in-fact is authorized to act) March 14,2017 IN WETNESS WI-EREOF,the Corporation has caused these presents to be duly signed and its corporate seal to be hereunto affixed and attested this 15th day of March,2016 at Purchase,New York (Corporate Seal) ENDURANCE REINSURANCE CORPORATION OF AMERICA ATTEST/172A,�x�- Irl. Byt�if4Yl _ 1 MARIANNE L WIILBERT,SENIOR VICE PRESIDENT SHARON L SIMS,SENIOR VICE PRESIDENT STATE OF NEW YORK ss Purchase COUNTY CF WESTCHESTER Cn the 15th day of,t rc r,1O16 b2frareyne personally came SHARCN L SIMS,SENIOR VICE PRESIDENTIo me known,who being by me duly sworn,did depose and say that(s)he resides in kCliiki-111:011401,IRIIIERSEY that(s)he is a SENIOR VICE PRESIDENT of ENDURANCE REINSURANCE CORPORATION CF AMERICA,the Corporation described in and which gin filed the bone angriLthal(s)he knows the seal of said Corporation;that the seal affixed to said instrument is such corporate seal,that it was so affixed by order of the kardiffDirapieio 94d4o2orWdn acid that(s)he signed his(her)name thereto by like order (Notapal 9 111 r3. 0.‘,IALIFfg 6 IR bt,„: iA ifttfSl�COt.I► CO ti1M EF; k . MARIA ARROYO,Notary Pudic-My Commission Expires ,w, O.h h tO(1 , 02232017 AP►a,gtic*- fir, CERTIFICATE STATE OF tiEV7Y �"44 ¢s'Purchase COUNTY CF k EfT • {1ER * ; I,CHRISTOPHER DCNELAN the PRESIDENT of ENDURANICE REINSURANCE CORPORATICN OF AMERICA,a Delawae Corporation(the'Corporatiort),hereby certify 1.That the original power of attorney of which the foregoing is a copy was duly executed on behalf of the Corporation and has not since been revoked amended or modified;that the undersigned has compared the foregoing copy thereof with the original power of attorney,and that the same is a true and correct copy of the anginal power of attorney and of the whole thereof, 2 The following are resolutions which were adopted by the Board of Directors of the Corporation by unanimous written consent on January9,2014 and said resolutions have not since been revoked,amended or mortified 'RESOLVED,that each of the individuals named below is authored to make,execute,seal and deliver for aid on behalf of the Corporation any and all bonds,undertakings or obligations in surety or co-surety with others ,,. CHRISTOPHER DONELAN,SHARON L.SIMS,MARIANNE L.WILBERT And be it further.'.k f {_S)4,1 RESCLV,ED bI e don named above is authorized to appoint attorneys-in-fact for the purpose of making,executing,sealing and delivering bonds,undertakings or obligalidr nsuy ® u p dlg aIalfoftheCorporation' 3 Tkfinder4ned further certifies that tfe'r'tye resolutions we true and correct copies of the resolutions as so recorded and of the whole thereof 25th da N7,41 ESS WFEIa 1.,RAW hereunto sekrttq hand and affixed the seal Ills y of April 20 16 :r11 c.1'...ser"a A.. . (Carr rate Seal) Ali i"s 17.1-1,1{ Y...;' = .;•• • CIRISTOPI-ER DONELAN,PRESIDENT My reproductions ore rod. .. Bond No. ERCA941700232 Premium: $11,104.00 PERFORMANCE BOND Executed in duplicate KNOW ALL PERSONS BY THESE PRESENTS that: WHEREAS the City of Rancho Palos Verdes ("Public Agency"),has awarded to Pro Tech Engineering Corporation dba Pro Tech Electric 1051 N. Patt Street,Anaheim, CA 92801 (Name and address of Contractor) ("Principal"), a contract (the "Contract") for the work described as follows: HAWTHORNE BLVD SIGNAL SYNCHRONIZATION PROJECT.FEDERAL PROJECT NO.HSIPL-5413(014) WHEREAS, Principal is required under the terms of the Contract to furnish a bond for the faithful performance of the Contract. NOW, THEREFORE,we,the undersigned Principal,and Endurance Reinsurance Corporation of America 4 Manhattanville Road, Purchase, NY 10577 (Name and address of Surety) ("Surety") a duly admitted surety insurer under the laws of the State of California, as Surety, are held and firmly bound unto the Public Agency in the penal sum of Seven Hundred Sixty Thousand Three Hundred Seventy Two &75/100 Dollars($760,372.75 ), this amount being not less than the total contract price,in lawful money of the United States of America, for the payment of which sum well and truly to be made, we bind ourselves,our heirs,executors,administrators,successors,and assigns,jointly and severally,firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH THAT,if the hereby bounded Principal,his,her or its heirs,executors,administrators,successors or assigns,shall in all things stand to and abide by,and well and truly keep and perform all the undertakings, terms, covenants, conditions and agreements in the Contract and any alteration thereof made as therein provided, on the Principal's part to be kept and performed,all within the time and in the manner therein specified,and in all respects according to their true intent and meaning, and shall indemnify and hold harmless the Public Agency, its officers, agents, and others as therein provided,then this obligation shall become null and void;otherwise,it shall be and remain in full force and effect. In case suit is brought upon this bond,Surety further agrees to pay all court costs and reasonable attorneys' fees in an amount fixed by the court. FURTHER,the Surety,for value received,hereby stipulates and agrees that no change,extension of time, alteration,addition or modification to the terms of the Contract,or of the work to be performed thereunder, or the specifications for the same,shall in any way affect its obligations under this bond,and it does hereby waive notice of any such change,extension of time,alteration,addition,or modification to the terms of the Contract or to the work or to the specifications thereunder. Surety hereby waives the provisions of California Civil Code'2845 and 2849. The City is the principal beneficiary of this bond and has all rights of a party hereto. Spc09-43 C-7 IN WITNESS WHEREOF, two (2) identical counterparts of this instrument, each of which shall for all purposes be deemed an original hereof, have been duly executed by Principal and Surety,on the date set forth below,the name of each corporate party being hereto affixed and these presents duly signed by its undersigned representative(s)pursuant to authority of its governing body. Dated: April 25th, 2016 "Principal" "Surety" Pro Tech Engineering Corporation Endurance Reinsurance Corporation dba Pro Tech Electric of America By: /L LTi [ �2��'C) By: Itt Its Stephanie Hang, attorney-in-Fact By: By: Its Its (Seal) (Seal) APPROVED AS TO SURETY AND APPROVED AS TO FORM: PRINCIPAL AMOUNT ALESHIRE&WYNDER,LLP A Professional Corporation By: By: Insurance Administrator Public Agency Attorney Note: This bond must be executed in duplicate and dated,all signatures must be notarized,and evidence of the authority • of any person signing as attorney-in-fact must be attached Spc09-43 C-8 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT 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 truthfulness,accuracy,or validity of that document. State of California ) County of Orange ) Onq3,&--// co before me, Barbara Copeland ,Notary Public, personally appeared Stephanie Hoang Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s-) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s)acted, executed the instrument. I certify under PENALTY OF PERJURY under the BARBARA COPELAND laws of the State of California that the foregoing F1� `,: Commission #2016348 h is true and correct. �- paragraph p a =�•� :' Notary Public-California z "1!'1! Orange County WITNESS m and and official seal._ __'_ _ My Comm.Expires Apr 19,2017 y� Signature: ,t - Signature ofbd tare Public Place Notary Seal Above -------- ----------_ OPTIONAL — --- Though the information below is not required by law, it may prove valuable to persons relying on the document and could present fraudulent and reattachment of this form to another document. Description of Attached Document Type or Title of Document: Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Capacity(ies)Claimed by Signer(s) Signer's Name: Stephanie Hoang Signer's Name: ❑ Individual ❑ Individual ❑ Corporate Officer-Title(s): ❑ Corporate Officer-Title(s): ❑ Partner: ❑Limited ❑ General ❑ Partner: ❑Limited ❑General ® Attorney in Fact El Attorney in Fact ❑ Trustee ❑ Trustee ❑ Guardian or Conservator ❑ Guardian or Conservator ❑ Other: ❑ Other: Signer Is Representing: Signer Is Representing: Rev. 1-15 R • •.r ENDURANCE REINSURANCE CORPORATION OF AMERICA ERCA941700232 POWER OF ATTORNEY Know all Men 6Y these , that ENDURANCE REINSURANCE CORPORATION OF AMERICA,a Delaware corporation(the'Corporation"),with offices at 4 Manhattanville Road,3rd Floor,Purchase,NY 10577,has made,constituted and appointed and by These presents,does make,constitute and appoint ERIC LOWEY,MARK RICHARDSON,SHAWN BLUME,STEPHANIE HOANG its true and lawful Attomey(s)-in-fact,al COSTA MESA in the State of CA and each of them to have full power to act without the other or others,to make,execute and deliver on its behalf,as surety or co-surety,bonds and undertakings given for any and all purposes,also to execute and deliver on its behalf as aforesaid renewals,extensions,agreements,waivers,consents or stipulations relating to such bands or undertakings provided,however,that no single bond or undertaking so made,executed and delivered shall obligate the Corporation for any portion of the penal sum thereof in excess of the sum ofSEVEN MILLION FIVE HUNDRED THQUSAN��D,,Dollars($7,500,000) Such bond i n i rta(x(irrrigsT oses,when duly executed by said altorney(s)-in-fact,shall be binding tpon the Corporation as fully and to the same extent as if signed by the Pres dlq Tth aigiOVri(sforporate seal attested by its Corporate Secretay This Aeitftntriseq made under AO)au ity of cerlan resolutions adopted by the Board of Directors of the Corporation by unanimous written consent on the9th of January,2014, a cogwhdh appears below under the healihtj entitled'Certificate ThmaawerofAttorrEey{s jkndsealed'I acsimileunderandbyauthorityofthefollowingresolutionadoptedbytheBoardofDirectorsoftheCorporationbyunanmouswritten cors pt on January 4.0i!il said resotutio n*as not since been revoked,amended or repealed. REE D,bat in granting powers of attorrtey.pursuant to certain resolutions adopted by the Board of Directors of the Corporation by unanimous written consent on January9,2014, sr�r the lyre directors arnit o'�erss'do•'ri•Te seal of the Corporation maybe affixed to any such power of attorney or any certi ficate relating thereto by facsimile,and any such power orn y$ir,er)i)tq le qp iing S csimile signature or seal shall be valid and binding upon the Corporation in the future with respect to any bond or undertaking to which it isaltache$•:' }i` i r Fa° •';r This Power of Rltorp.cy ha l Wpge and all authonty hereunder shall terminate without notice al midnight(Standard Timer where said attomey(s)-in-fact is authorized to act) March 14,2017 IN WITNESS WI-EREOF,the Corporation has caused these presents to be duly signed and its corporate seal to be hereunto affixed and attested this 15th day of March,2016 al Purchase,New York (CorporateATTEST Seal) ENDURANCE REINSURANCE CORPORATION CF AMERICA By fJ� -�¢ �IJ�� /:/ _ MARIANNE L.WILBERT,SENIOR VICE PRESIDENT SHARON L.SIMS,SENIOR VICE PRESIDENT STATE CF NEW YORK ss Purchase COUNTY CF WESTCHESTER On the 15th day of lArcfh,2016 btfcireyne personally came SHARON L.SIMS,SENIOR VICE PRESIDENTto me known,who being by me duly sworn,did depose and say that(s)he resides in$,,I)T.C4-111LA1414,pllpJERSEY that(s)he is a SENIOR VICE PRESIDENT of ENDURANCE REINSURANCE CORPORATION CF AMERICA,the Corporation described in and which erliklted the3.bove(rr ri)hat(s)he knows the seal of said Corporation,that the seal affixed to said instrument is such corporate seal,that it was so affixed by order of the Abard®f Diri orOo aAJ/Qciporaifon ore t that(s)he signed his(her)name thereto by like order (Notapal 9�q + 110. QifALIP$66 IW ilf TCt�Es1F [dart Lb 1411 EXP. MARIA ARROYO,Notary Pudic-My Commission Expires A 07/2.311011 c 02232017 'Pcj t I C. ,{`' CERTIFICATE STATE CFF NE OG(Fij.L� gs Purchase COUNTY OF 1RE8TjE TER• CI-RISTCPHER DONELAN the PRESIDENT of ENDURANCE REINSURANCE CORPORATION OF AMERICA,a Delawae Corporation(the'Corporatiorf),hereby certify 1 That the original power of attorney of which the foregoing is a copy was duly executed on behalf of the Corporation and has not since been revoked amended or modified;that the undersigned has compared the foregoing copy thereof with the original power of attorney,and that the same is a true and correct copy of the anginal power of attorney and of The whole thereof, 2 The following are resolutions which were adopted by the Boat of Directors of the Corporation by unanimous written consent on Jaruary9,2014 and said resolutions have not since been revoked,amended or modified 'RESOLVED,that each of the individuals named below is authorized to make,execute,seal and deliver for and on behalf of the Corporation any and all bonds,undertakings or obligations in surety or co-surety with others: r„ CHRISTOPHER DONELAN,SHARON L.SIMS,MARIANNE L.WILBERT And be it further: `cu C f RESOL rAl'e. dndivierinamed above is authorized to appoint attorneys in-fact for the purpose of making,executing,sealing and delivering bonds,undertakings or obtiga r4n see d �Pdl�hatf of the Corporation' 3 T3rte+` PSa t r�tjhder fried f rthercertifies that The hive resolutions are true and correct copies of the resolutions as so recorded and of the whole thereof 25th dayof .20 16 IN_FSS Wf E ,4 �e hereunto setp hand and afro ed the corporate seal the April (C6rr.14 ale Seal) 2. t f.•y`. t 3 CFRISTOPI ER DONELAN,PRESIDENT • Any repro:Wnns ore rad.