06B SPEC#3829R-BF.pdf

BID FORMS

SCHEDULE OF BID PRICES

La Crescenta Avenue Rehabilitation Project Specification No. 3829R

BID FORMS

F-1

The undersigned Bidder submits this Bid in response to the Notice Inviting Bids issued by the City to construct the Work of the following Project in accordance with the Contract Documents:

PROJECT: La Crescenta Avenue Rehabilitation Project, Specification No. 3829R

BIDDER’S NAME: _________________________________________________

Deliver or mail to: Office of City Clerk City of Glendale 613 E. Broadway, Room 110

Glendale, California 91206

A. Enclosed herewith this letter and by this reference incorporated herein and made a part of this Bidder’s Bid are the following completed forms:

1. Bidder’s Proposal

2. Schedule of Bid Prices

3. Incumbency Certificate

4. Bid Security in the following form (check one):

5. Bidder’s Statement of Qualifications

6. Experience Form

7. Specialty Contractor’s Statement of Qualifications (ETA)

8. Specialty Contractor’s Statement of Qualifications (IMSA)

9. Contractor’s References – All Projects

10. Contractor Safety Questionnaire

11. Questionnaire Regarding Subcontractors

12. Designation of Subcontractors

13. Contractor’s Declaration of Noncollusion

14. Insurance Requirements Affidavit

B. Acknowledgment of Addenda. The Bidder shall acknowledge the receipt of Addenda by placing an “X” by each Addendum received:

Addendum No. 1 Addendum No. 2 Addendum No. 3

Cashier’s Check Certified Check Bid Bond Cash

Specification No. 3829R

BID FORMS

F-2

Addendum No. 4 Addendum No. 5

If an Addendum or Addenda have been issued by the City and not noted above as being received by the Bidder, the Bid may be rejected.

C. Inspection of the Work and Contract Documents. Bidder certifies that it has carefully examined and is fully familiar with all of the provisions of the Bidding Documents and said Bidding Documents contain sufficient detail regarding the Work to be performed; that it has notified City of any errors or omissions in the Bidding Documents and/or any unusual site conditions; and that it has carefully checked all words, prices, and statements in this Bidding Document.

D. Bidder hereby certifies that he/she and his/her Subcontractors have inspected the site and related Drawings and Specifications of Work and fully acquainted themselves with all conditions and matters which may in any way affect the Work, time of completion or the costs thereof. Bidder also certifies he/she has observed the designated Contractor Work areas and access routes, if disclosed or shown, as part of the Work in this Contract.

SITE INSPECTION – CERTIFICATION:

Person(s) who inspected site of the proposed Work for your firm:

Name: _______________________________________ Date of Inspection: ________________

Title: _______________________________________

Name: _______________________________________ Date of Inspection: ________________

Title: _______________________________________

E. Mandatory Pre-Bid Meeting. N/A

F. Bidder agrees that all costs of Work shown in the Bidding Documents, including work reasonably inferable therefrom and necessary thereto, are included in his/her Bid. All Work shown in the Contract Documents for which a specific line item is not provided in the Bidding Form is included in the Bidder’s Base Bid sum. Contractor shall be reimbursed for the actual direct cost of all Permit Fees, as defined in Paragraph 1.01 and addressed in Paragraph 1.03 of the General Conditions. Bidder shall exclude the cost of Permit Fees from Bidder’s Base Bid sum. Base Bid sum shall include the cost of administration and coordination of Governmental Approvals and Utility Fees. Bidder agrees that City will not be responsible for any errors or omissions on the part of the undersigned in making this Bid.

G. Forfeiture of Bid Security. Bidder further agrees that, in case of his/her default in executing the required Contract and the required bonds, or furnishing the required insurance, the money payable under the Bid Security accompanying this Bid shall be applied by the City towards payment of the damage to the City on account of such default, as provided in the Bidding Documents.

H. Period of Irrevocability. Bidder agrees that this Bid shall remain open and shall not be withdrawn for a period of not less than ninety (90) calendar days after bid deadline, or until rejected by the City, whichever period is shorter.

I. Bid Dispute Indemnification. In the event of a Bid dispute or protest based upon the Bidder’s submission of this Bid and the City acceptance of same, the Bidder receiving award of the Contract will be required to indemnify, defend (with counsel acceptable to City), and hold harmless at Bidder’s expense, the City, its City Council members, it’s agents, Specification No. 3829R

BID FORMS

F-3 employees, and officers from liability, claims, demands, damages, and costs arising therefrom.

J. The California contractor license number listed below has been issued to the undersigned Bidder. This license has not been revoked or suspended and is in full force and effect and authorizes the undersigned Bidder to perform the Work under these Contract Documents. If Bidder is a joint venture and has not yet been issued a license, indicate the license number to be used for the joint venture and attach documentation providing assurances that the license will be issued on or before the award of the Contract.

K. Bidder certifies that before submitting this Bid, Bidder and Bidder’s listed subcontractors have met the requirements of the Public Works Contractor Registration Law (California Senate Bill No. 854 - Labor Code Section 1725.5) and have registered with the California Department of Industrial Relations (DIR).

I hereby certify under penalty of perjury under the laws of the State of California that the representations made herein are true and correct.

Executed this ________ day of _______________ at __________________________ , ___________________

City State

COMPANY NAME: _______________________________________________________________

ADDRESS: _______________________________________________________________

CONTACT PERSON: _______________________________________________________________

TELEPHONE NUMBER: __________________________ FAX NUMBER: _____________________

E-MAIL: _______________________________________________________________

CONTRACTOR LICENSE NO.: _______________________________________________________________

LICENSE CLASS : ___________________________ EXPIRATION DATE: _________________

DEPARTMENT OF INDUSTRIAL RELATIONS

CONTRACTOR REGISTRATION NO.: _________________________ EXPIRATION DATE: _________________

TAX IDENTIFICATION NO.: _______________________________________________________________

SURETY COMPANY: _______________________________________________________________

All Bid forms must be signed where so indicated by the person or persons duly authorized to sign on behalf of the Bidder [see page IB-2, Paragraph 5 A-E]. By signing the Bid, the person signing is deemed to represent that he or she has authority to bind the Bidder. Failure to sign the Bidder’s Proposal may invalidate the Bid.

BIDDER’S PROPOSAL – SIGNATURE(S):

Form of Entity of Bidder:

Please check the appropriate signature block below and fill in all related information.

Sole Proprietorship:

By: _____________________________________ Title: _____________________________________ Printed name of person signing

Specification No. 3829R

BID FORMS

F-4

Signature

Partnership: General Partner Limited Partner

Printed Name of person signing

Corporation:

By: _____________________________________ Corporate Officer Title: _______________________ Printed Name of person signing

Joint Venture: Corporation Partnership Individual Other ______________________________ By: _____________________________________ Title: _____________________________________ Printed Name of person signing

Limited Liability Company:

Printed Name of person signing

Corporate Seal

Specification No. 3829R

BID FORMS

F-5

PROJECT: La Crescenta Avenue Rehabilitation Project, Specification No. 3829R

BIDDER’S NAME: _________________________________________________

BASE BID

Pursuant to and in compliance with your Notice Inviting Bids and Contract Documents relating to the Project including all Addenda, Bidder, having become thoroughly familiar with the terms and conditions of the Contract Documents and with local conditions affecting the performance and the costs of the Work at the place where the Work is to be done, hereby proposes and agrees to furnish and install everything necessary for and incidental to fully perform the base Contract Work within the time stated in strict accordance with the Contract Documents for the Base Bid price of:

(written dollar amount) (dollar amount)

La Crescenta Avenue Street Improvements Plan No. 1-3071

Item No. Article Estimated Quantity Units Unit Price Total Price

1 PAVEMENT REMOVAL AND GRADING 528 CY

2 PAVEMENT REMOVAL, SURFACE

PLANE (2-INCHES) 14,223 SY

3 PAVEMENT REMOVAL, SURFACE

PLANE (3-INCHES) 39,292 SY

4 OVER-EXCAVATION OF SUB-GRADE

(2-INCH TO 6-INCH DEEP) * 541 CY

5 CRUSHED AGGREGATE BASE 219 TONS

6 CRUSHED MISCELLANEOUS BASE 1,529 TONS

7 ASPHALT CONCRETE PAVEMENT

(SURFACE AND BASE COURSE) 1,194 TONS

8 ASPHALT CONCRETE (LEVELING

COURSE) 2,739 TONS

9 ASPHALT RUBBER HOT MIX (ARHM) 6,698 TONS

Dollars ($ )

Specification No. 3829R

BID FORMS

F-6

10 ASPHALT RUBBER AGGREGATE

MEMBRANE (ARAM) 12,174 SY

11 CONSTRUCT P.C.C. CURB 2,376 LF

12 CONSTRUCT INTEGRAL P.C.C. CURB

AND GUTTER 2,940 LF

CONSTRUCT 4-INCH P.C.C.

PAVEMENT (SIDEWALK, WALKWAY,

CURB RAMPS)

31,727 SF

CONSTRUCT 5-INCH P.C.C.

PAVEMENT (RESIDENTIAL DRIVEWAY

AND APPROACH)

2,479 SF

CONSTRUCT 6-INCH P.C.C.

PAVEMENT (ALLEY APRON,

COMMERCIAL DRIVEWAY AND

APPROACH)

1,587 SF

CONSTRUCT 8-INCH P.C.C.

PAVEMENT (LOCAL DEPRESSION,

CROSS GUTTER)

10,588 SF

17 CONCRETE GRINDING 12 LF

18 MODIFY/EXTEND EXISTING CATCH

BASIN OPENING 1 LS

19 RECONSTRUCT/REMODEL CURB

DRAIN 8 EA

REMOVE EXISTING PAVEMENT

(AC/PCC/BRICK PAVEMENT OR

LANDSCAPING)

3,205 SF

REGRADE AND INSTALL GROUND

COVER/GRASS LAWN TO MATCH

EXISTING

2,361 SF

22 ADJUST/REPLACE TRAFFIC SIGNAL

PULL BOX AND COVER 8 EA

23 PLANT 24-INCH BOX TREE (VARIOUS

TYPES IN TREE WELL/PARKWAY) 20 EA

SAWCUT AND REMOVE EXISTING

P.C.C. SIDEWALK AND EXPAND TREE

WELL

324 SF

25 RELOCATE EXISTING BUS BENCH

AND SIGN TO PROPOSED LOCATION 1 LS

INSTALL CAST-IN-PLACE

DETECTABLE WARNING SURFACE

ON ADA CURB RAMPS

642 SF

27 RELOCATE EXISTING TRASH

RECEPTABLE TO NEW LOCATION 1 EA

Specification No. 3829R

BID FORMS

F-7

28 ADJUST MANHOLE FRAME AND

COVER SET 59 EA

29 REPAIR EXISTING

RETAINING/SLOUGH WALL 20 LF

30 RELOCATE EXISTING SIGN AND

POST 24 EA

31 CONSTRUCT PARKWAY DRAIN

(INLET/OUTLET)* 6 EA

32 REMOVE STREET LIGHT

FOUNDATION 2 EA

FURNISH AND INSTALL 6-FOOT

DIAMETER INDUCTIVE TRAFFIC

LOOP DETECTOR

4 EA

FURNISH AND INSTALL 1.5-INCH PVC

SCHEDULE 80 LOOP STUB-OUT

CONDUIT

2 EA

35 ADJUST/REPLACE CENTERLINE

TIE * 25 EA

36 ADJUST/REPLACE PROPERTY

CORNER * 20 EA

37 ADJUST/REPLACE BENCH MARK * 15 EA

38 ADJUST/REPLACE SURVEY WELL

MONUMENT * 5 EA

39 ADJUST GWP WATER VALVE TO

NEW FINISHED GRADE 51 EA

40 ADJUST GWP RECYCLED WATER

VALVE TO NEW FINISHED GRADE 3 EA

41 ABANDON FIRE HYDRANT LATERAL

AND VALVE. 1 EA

42 INSTALL NEW FIRE HYDRANT AND

ASSEMBLY 1 EA

ADJUST/REPLACE GWP WATER

METER BOX & COVER SET TO NEW

FINISHED GRADE

16 EA

RELOCATE EXISTING WATER METER

AND SERVICE TO PROPOSED

LOCATION

1 EA

REPLACE EXISTING GWP WATER

VALVE BOX AND COVER SET WITH 2-

PIECE CAST IRON SLIP TYPE WATER

VALVE BOX AND COVER SET

5 EA

Specification No. 3829R

BID FORMS

F-8

46 ADJUST CVWD WATER VALVE TO

NEW FINISHED GRADE 19 EA

ADJUST/REPLACE CVWD WATER

METER BOX & COVER SET TO NEW

FINISHED GRADE

13 EA

REPLACE EXISTING CVWD WATER

VALVE BOX AND COVER SET WITH 2-

PIECE CAST IRON SLIP TYPE WATER

VALVE BOX AND COVER SET

4 EA

ABANDON EXISTING GWP WATER

VALVE AND FILL VOID WITH

CRUSHED BASE

1 EA

50 INSTALL NEW WATER VALVE ON

EXISTING FIRE LINE 1 EA

La Crescenta Avenue Sewer Improvements Plan No. 3-1572

S1

REMOVE EXISTING MANHOLE AND

CONSTRUCT 4-FOOT DIAMETER

PRECAST CONCRETE SEWER

MANHOLE

6 EA

S2

CONSTRUCT 4-FOOT DIAMETER

PRECAST CONCRETE SEWER

MANHOLE

6 EA

S3

CONSTRUCT 4-FOOT DIAMETER

PRECAST CONCRETE DROP SEWER

MANHOLE

2 EA

S4

REMOVE EXISTING MANHOLE AND

CONSTRUCT 4-FOOT DIAMETER

PRECAST CONCRETE DROP SEWER

MANHOLE

3 EA

S5

REMOVE EXISTING 8-INCH VCP AND

CONSTRUCT 12-INCH PVC SANITARY

SEWER LINE

1,244 LF

S6 CONSTRUCT 12-INCH PVC SANITARY

SEWER LINE 1,415 LF

S7

RECONNECT HOUSE CONNECTION

LATERAL FOR 12-INCH PVC

MAINLINE SEWER

49 EA

S8 ABANDON EXISTING 8-INCH INLET

TO SEWER MANHOLE 5 EA

Specification No. 3829R

BID FORMS

F-9

S9

REMOVE, SALVAGE, AND REINSTALL

SECTION OF EXISTING GUARDRAIL

SYSTEM *

1 LS

S10

REMOVE, SALVAGE, AND REINSTALL

SECTION OF EXISTING 54-INCH RCP

STORM DRAIN MAIN LINE *

15 LF

S11 RECONSTRUCT SEWER MANHOLE

SHELF (8”-12” CHANNEL) 8 EA

S12

RECONSTRUCT SEWER MANHOLE

SHAFT, SHELF. AND CHANNEL

(8”-CHANNEL)

3 EA

S13

CCTV INSPECTION OF EXISTING

STORM DRAIN AND/OR SANITARY

SEWER LINE BEFORE AND AFTER

SEWER CONSTRUCTION *

497 LF

S14 SUPPORT EXISTING UTILITY 11 EA

S15 SUPPORT EXISTING UTILITY

(LARGER THAN 24-INCHES) 2 EA

S16 INSTALL SANITARY SEWER

ENCASEMENT * 128 LF

S17

FURNISH AND INSTALL EPOXY LINER

TO MANHOLE SHAFT, SHELF, AND

CHANNELS

6 EA

S18 SUPPORT EXISTING WATER LINE

PER GWP PLAN NO. 1668-A * 1 EA

S19

RECONSTRUCT 8-INCH VCP

SANITARY SEWER MAIN LINE (POINT

REPAIR)

61 LF

S20 INSTALL FULL CIPP LINING FOR 8-

INCH SANITARY SEWER MAIN LINE 198 LF

S21 INSTALL PARTIAL CIPP LINING FOR

8-INCH SANITARY SEWER MAIN LINE 18 LF

S22 REMODEL SEWER HOUSE

CONNECTION * 30 EA

La Crescenta Avenue Catch Basin Bicycle Friendly Surface Grate Installation Plan No. 4-650

G1 REMOVE AND RECYCLE EXISTING

CATCH BASIN GRATES 99 EA

G2 FURNISH AND INSTALL BICYCLE

PROOF CATCH BASIN GRATE 99 EA

Specification No. 3829R

BID FORMS

F-10

G3 LOS ANGELES COUNTY FLOOD

CONTROL PERMIT FEE ALLOWANCE 1

PERMIT

FEE

ALLOW-

ANCE

$2,000 $2,000

Traffic Striping, Pavement Markings, and Signs Plan No. 49-247

T1

INSTALL THERMOPLASTIC WHITE

TYPE IV (L) PAVEMENT MARKING

ARROW PER CALTRANS STANDARD

PLAN NO. A24A.

14 EA

T2

INSTALL THERMOPLASTIC WHITE

TYPE IV (R) PAVEMENT MARKING

ARROW PER CALTRANS STANDARD

PLAN NO. A24A.

3 EA

T3

INSTALL THERMOPLASTIC 8-INCH

WIDE SOLID YELLOW DIAGONALS

(ANGLED 30 TO 45 DEGREES) WITH

40’ O.C. SPACING WITH TYPE D

TWO-WAY YELLOW R.P.M. PER

CALTRANS STANDARD PLAN NO.

A20D.

144 LF

T4

INSTALL CALTRANS APPROVED

PREFORMED THERMOPLASTIC

WHITE “SHARROW” WITH GREEN

BACKGROUND PAVEMENT SHARE

LANE SYMBOL PER CITY OF

GLENDALE PLACEMENT

STANDARDS

5 EA

T5

INSTALL THERMOPLASTIC 8-FOOT

HIGH “STOP” PAVEMENT MARKINGS

PER CALTRANS STANDARD PLAN

NO. A24D.

27 EA

T6

INSTALL THERMOPLASTIC 6-INCH-

WIDE SOLID WHITE BIKE LANE LINE

PER CALTRANS STANDARD PLAN

NO. A20D, DETAIL 39

20,097 LF

T7

INSTALL THERMOPLASTIC 6-INCH-

WIDE SKIP WHITE BIKE

INTERSECTION LINE PER CALTRANS

STANDARD PLAN NO. A20D, DETAIL

39A.

5,234 LF

T8

INSTALL THERMOPLASTIC 6-INCH-

WIDE YELLOW TWO-WAY LEFT-

TURN LANE WITH TYPE D TWO-WAY

YELLOW R.P.M. PER CALTRANS

STANDARD PLAN NO. A20B, DETAIL

32.

5,673 LF

T9 INSTALL THERMOPLASTIC 6-INCH-

WIDE SOLID DOUBLE YELLOW 2,667 LF

Specification No. 3829R

BID FORMS

F-11

CENTERLINE SEPARATED BY A 3-

INCH SOLID BLACK STRIPE WITH

TYPE D TWO-WAY YELLOW R.P.M.

PER CALTRANS STANDARD PLAN

NO. A20A, DETAIL 22.

T10

INSTALL THERMOPLASTIC 8-INCH-

WIDE SOLID WHITE CHANNELIZING

LINE WITH TYPE G ONE-WAY CLEAR

R.P.M. PER CALTRANS STANDARD

PLAN NO. A20D, DETAIL 38.

1,381 LF

T11

INSTALL THERMOPLASTIC 12-INCH-

WIDE WHITE LIMIT LINE PER

CALTRANS STANDARD PLAN NO.

A24E.

1,490 LF

T12

INSTALL THERMOPLASTIC

CONTINENTAL CROSSWALK WITH

24-INCH-WIDE SOLID WHITE

LONGITUDINAL LINES SPACED 24

INCHES APART. LONGITUDINAL

LINES SHALL BE PARALLEL WITH

THE TRAVEL LANES. CROSSWALKS

SHALL HAVE TWELVE (12) FOOT

OUTSIDE DIMENSIONS.

672 SF

T13

REMOVE CONFLICTING STRIPING

AND PAVEMENT MARKINGS BY WET

SANDBLASTING PER SQUARE FOOT

272 SF

T14

INSTALL THERMOPLASTIC 4-INCH-

WIDE SOLID WHITE DIAGONAL LINES

(ANGLED 30 TO 45 DEGREES) AS

SHOWN ON PLANS, 20’ O.C.

3,118 LF

T15 INSTALL THERMOPLASTIC 4-INCH

WIDE SOLID WHITE LINE 7,114 LF

T16 INSTALL RIDE-A-WAY GREEN

COATING BIKE LANE PAINT 26,113 SF

T17

INSTALL K-71 BOLLARDS WHITE, 29-

INCH IN HEIGHT AND 7.5-INCH IN

DIAMETER WITH TWO (2) 4-INCH

REFLECTIVE COLLARS FOR 360

DEGREE REFLECTIVITY

464 EA

T18

INSTALL CALTRANS APPROVED

PREFORMED THERMOPLASTIC

GREEN BICYCLE BOX

2,204 SF

T19

INSTALL CALTRANS APPROVED

PREFORMED THERMOPLASTIC

BICYCLE LOOP DETECTOR SYMBOL

14 EA

T20

INSTALL THERMOPLASTIC 8-INCH-

WIDE SOLID YELLOW DIAGONAL

LINES (ANGLED 30 TO 45 DEGREES)

AS SHOWN ON PLANS, 20’ O.C.

170 LF

Specification No. 3829R

BID FORMS

F-12

T21

INSTALL THERMOPLASTIC 6-INCH-

WIDE YELLOW LEFT EDGE LINE PER

CALTRANS STANDARD PLAN NO.

A20B, DETAIL 25.

47 LF

T22

INSTALL THERMOPLASTIC 6-INCH-

WIDE WHITE LANE LINE

EXTENSIONS THROUGH

INTERSECTION PER CALTRANS

STANDARD PLAN NO. A20D, DETAIL

40.

108 LF

T23

INSTALL THERMOPLASTIC 6-INCH-

WIDE YELLOW CENTER LINE

EXTENSIONS THROUGH

INTERSECTION PER CALTRANS

STANDARD PLAN NO. A20D, DETAIL

41.

111 LF

T24

REMOVE CONFLICTING STRIPING

AND PAVEMENT MARKINGS BY WET

SANDBLASTING PER LINEAR FOOT

4,111 LF

T25

FURNISH AND INSTALL 2"

GALVANIZED SQUARE TUBING SIGN

POLE

25 EA

T26 FURNISH AND INSTALL SIGN TO

NEW POST PER PLAN 30 EA

T27 RELOCATE EXISTING POLE AND

SIGN AS SHOWN ON THE PLAN 3 EA

T28

INSTALL, EXTEND AND/OR

REFURBISH PAINTED

RED/BLUE/GREEN/YELLOW/WHITE

CURB MARKING

4,390 LF

T29

INSTALL THERMOPLASTIC 6-INCH-

WIDE WHITE RIGHT EDGE LINE PER

CALTRANS STANDARD PLAN NO.

A20B, DETAIL 27B

61 LF

T30 REMOVE AND SALVAGE EXISTING

STREET SIGN AND POST 15 EA

T31

INSTALL CALTRANS APPROVED

PREFORMED THERMOPLASTIC

WHITE BIKE LANE SYMBOL WITH

PERSON PAVEMENT MARKING WITH

GREEN BACKGROUND

9 EA

T32

INSTALL THERMOPLASTIC 6-INCH-

WIDE SOLID WHITE LANE LINE WITH

TYPE G ONE WAY CLEAR R.P.M.

150 LF

T33

INSTALL THERMOPLASTIC 6-INCH-

WIDE SKIP WHITE LINE PER

CALTRANS STANDARD PLAN NO.

A20A, DETAIL 8.

540 LF

Specification No. 3829R

BID FORMS

F-13

T34

INSTALL PREFORMED

THERMOPLASTIC WHITE BIKE LANE

SYMBOL WITHOUT PERSON

PAVEMENT MARKINGS WITH GREEN

BACKGROUND

62 EA

T35

INSTALL PREFORMED

THERMOPLASTIC WHITE BIKE LANE

ARROW PAVEMENT MARKING WITH

GREEN BACKGROUND

62 EA

T36

REMOVE EXISTING SIGN AND

REPLACE WITH NEW SIGN AS

INDICATED ON PLAN, PROTECT IN

PLACE THE EXISTING SQUARE

TUBING SIGN POLE

4 EA

T37

REMOVE AND SALVAGE EXISTING

POST. RELOCATE EXISTING STREET

NAME SIGN ONTO NEW POLE AS

INDICATED ON PLANS.

8 EA

T38

INSTALL THERMOPLASTIC 8-INCH

WIDE WHITE LANE DROP AT

INTERSECTION LINE WITH TYPE G

ONE-WAY CLEAR

RETROREFLECTIVE PAVEMENT

MARKERS PER CALTRANS

STANDARD PLAN NO. A20C, DETAIL

37B.

356 LF

T39

INSTALL THERMOPLASTIC 8-FOOT

HIGH “HERE” PAVEMENT MARKINGS

PER CALTRANS STANDARD PLAN

NO. A24D.

2 EA

T40

INSTALL THERMOPLASTIC 8-FOOT

HIGH “WAIT” PAVEMENT MARKINGS

PER CALTRANS STANDARD PLAN

NO. A24D.

2 EA

T41

INSTALL THERMOPLASTIC 8-FOOT

HIGH “KEEP” PAVEMENT MARKINGS

PER CALTRANS STANDARD PLAN

NO. A24E.

2 EA

T42

INSTALL THERMOPLASTIC 8-FOOT

HIGH “CLEAR” PAVEMENT

MARKINGS PER CALTRANS

STANDARD PLAN NO. A24E.

2 EA

Specification No. 3829R

BID FORMS

F-14

Traffic Signal Modification Plan Nos. 50-672, and 50-673

MRT1

FURNISH AND INSTALL TRAFFIC

SIGNAL MODIFICATION ON LA

CRESCENTA AVENUE AT

ROSELAWN AVENUE

1 LS

MRT2

FURNISH AND INSTALL TRAFFIC

SIGNAL MODIFICATION ON LA

CRESCENTA AVENUE AT

SHIRLYJEAN STREET

1 LS

Traffic Signal Modification, Traffic Signal Installation, Mid-Block Signalized Bicycle Crossing, and Pedestrian Hybrid Beacon Installation

Plan Nos. 50-638, 50-639, 50-648, 50-698, and 50-699

MM1

FURNISH AND INSTALL MID-BLOCK

BICYCLE CROSSING SIGNAL ON LA

CRESCENTA AVENUE BETWEEN

ARLINGTON AVENUE AND LAS

PALMAS AVENUE

1 LS

MM2

FURNISH AND INSTALL TRAFFIC

SIGNAL ON LA CRESCENTA AVENUE

AT OAKMONT VIEW DRIVE

1 LS

MM3

FURNISH AND INSTALL PEDESTRIAN

HYBRID BEACON ON LA CRESCENTA

AVENUE AT PIEDMONT AVENUE

1 LS

MM4

FURNISH AND INSTALL TRAFFIC

SIGNAL MODIFICATION ON LA

CRESCENTA AVENUE AT

MONTROSE AVENUE

1 LS

MM5

FURNISH AND INSTALL TRAFFIC

SIGNAL MODIFICATION ON LA

CRESCENTA AVENUE AT HONOLULU

AVENUE

1 LS

BID TOTAL $____________________

If there is a difference between the amount shown in words for a bid and the amount shown in numbers, the amount in words shall have precedence.

Bidder shall exclude the cost of Permit Fees from Bidder’s Base Bid price. Base Bid price shall include the cost of administration and coordination of Governmental Approvals and Utility Fees.

SCHEDULE OF BID PRICES (continued)

Specification No. 3829R

BID FORMS

F-15

Items marked with a (*) indicates that quantities shown are for bidding purposes only. These items and quantities may or may not be used, at the discretion of the engineer. The Engineer shall determine the exact locations and quantities, if any, where the above quantities will be needed.

Bidder acknowledges that determination of the lowest Bid will be based on the combined total of the prices entered above for the Base Bid plus all of the listed Bid Alternate items, and that once the low Bid is determined on this basis, the City will be free to select Bid Alternates for inclusion in the Work in any order or combination, or to reject any or all Bid Alternates.

ADDITIVE BID ALTERNATE ITEMS:

Creative Crosswalks, Reflective Pavement, Drywell, Bio-Retention, and Fiber Optic Installation Plan Nos. 4-649, 18-114, 49-247, and 70-113

Item No. Article Estimated Quantity Units Unit Price Total Price

ABA1 CONSTRUCT DRYWELL SYSTEM 7 EA

ABA2 INSTALL BIO-RETENTION AREA 3,146 SF

ABA3

INSTALL NEW 1-INCH WATER

SERVICE LATERAL AND WATER

METER BOX

2 EA

ABA4

FURNISH AND INSTALL METAL

GUARD RAILING AND ACCESS GATE

AROUND BIO-RETENTION AREA

(HT=2’-6”)

395 LF

ABA5 INSTALL CLASS “A” TOPSOIL 117 CY

ABA6 INSTALL SOIL AMENDMENTS 117 CY

ABA7 5 GALLON SHRUBS 16 EA

ABA8 1 GALLON SHRUBS 42 EA

ABA9 GROUNDCOVER FLATS/PLUGS 3,146 SF

ABA10 BIO-RETENTION IRRIGATION

SYSTEM 1 LS

ABA11 FURNISH AND INSTALL CREATIVE

CROSSWALK 3,876 SF

ABA12 FURNISH AND INSTALL REFLECTIVE

PAVEMENT 18,500 SF

Specification No. 3829R

BID FORMS

F-16

ABA13

FURNISH AND INSTALL FIBER

READY 3” RIGID PVC SCHEDULE 80

CONDUIT WITH #10 AWG GREEN

TRACER WIRE AND PULL ROPE

3,556 LF

ABA14

FURNISH AND INSTALL OPTICAL

FIBER CABLE (48 SMFO) IN FIBER

READY CONDUIT

3,446 LF

ABA15

FURNISH AND INSTALL OPTICAL

FIBER CABLE (12 SMFO) IN FIBER

READY CONDUIT

110 LF

ABA16

FURNISH AND INSTALL 48-STRAND

CAPACITY AIR TIGHT SEAL FIBER

SPLICE ENCLOSURE

4 EA

ABA17

FURNISH AND INSTALL 19-INCH

RACK-MOUNT 12-STRAND CAPACITY

FIBER PATCH PANEL WITH RAILS

2 EA

ABA18

FURNISH AND INSTALL 19-INCH

RACK-MOUNT SURGE PROTECTION

POWER UNIT

2 EA

ABA19 FURNISH AND INSTALL NO. 6E FIBER

OPTIC PULL BOX 13 EA

ABA20 FURNISH AND INSTALL LAYER 2

GIGABIT ETHERNET SWITCH 2 EA

ABA21

FURNISH AND INSTALL PULL BOX

LID WITH “FIBER OPTIC”

INSCRIPTION

3 EA

ABA22 TERMINATE OR SPLICE FIBER

STRANDS 7 EA

ABA23

FURNISH AND INSTALL ALL

NECESSARY CONNECTORS,

CABLES, WIRES, AND EQUIPMENT

TO PROVIDE ETHERNET

COMMUNICATION

2 EA

ABA24

CORE DRILL EXISTING FOUNDATION

TO INSTALL 3” PVC SCHEDULE 80

CONDUIT FROM CONTROLLER

CABINET TO FIBER OPTIC PULL BOX

2 EA

ABA25 COIL 50-FEET OF 48-STRAND SMFO

CABLE IN PULL BOX 15 EA

TOTAL BID AMOUNT (Base Bid Price plus Additive Alternate Bid Nos. ABA1-25)

(written dollar amount) (dollar amount)

Dollars $

Specification No. 3829R

BID FORMS

F-17

Respectfully submitted:

Address

Title

Date

License Number Date of Expiration

Public Works Registration Number (PWCR)

(SEAL - if BID is by a corporation)

Attest

Amount of Certified or Cashier’s Check or Bid Bond

Name of Bonding Company

INCUMBENCY CERTIFICATE

Specification No. 3829R

BID FORMS

INCUMBENCY CERTIFICATE

F-18

Print legibly the names and title of the president and all officers of the Company who are authorized to sign the Bid Forms:

PRESIDENT’S & OFFICERS’ NAME: TITLE:

The undersigned hereby certifies to the City of Glendale that he/she is the duly elected and acting Secretary of _______________________________________ (the “Company”), and that, as such, he/she is authorized to execute this Incumbency Certificate on behalf of the Company, and further certifies that the persons named above are the duly elected, qualified and acting officers of the Company, holding on the date hereof, the titles and positions set forth opposite their names and are authorized to sign the Bid Forms.

IN WITNESS WHEREOF, the undersigned has executed this Incumbency Certificate this ______ day of _____________, 20__.

Secretary’s Name-Printed

Secretary’s Signature

BID FORMS

BID BOND

F-19

Bond No.:

Premium Amount: $ Bond’s Effective Date:

RECITALS:

1. The City of Glendale, California (“City”), has issued a Notice Inviting Bids for the Work described as follows:

Specification No. : in Glendale, CA. (“Project”)

2. In response to the Notice Inviting Bids, (Name, address, and telephone of Contractor) (“Principal”), has submitted the accompanying Bid for the Project.

3. Principal is required under the terms of the Specification— and all Bidding Documents referenced in it— to furnish a bond with the Bid.

4. The Specification, including all its amendments and supplements, and Principal’s Bid are incorporated into this Bond and made a part of it by this reference.

OBLIGATION:

THEREFORE, for value received, We, Principal and

(Name, address, and telephone of Surety)

(“Surety”), a duly admitted surety insurer under California’s laws, agree as follows:

By this Bond, We jointly and severally obligate and bind ourselves, and our respective heirs, executors, administrators, successors, and assigns to pay City the penal sum of Dollars ($ ) (“the Bonded Sum”), this amount comprising not less than TEN PERCENT (10%) of Principal’s Base Bid, in lawful money of the United States of America.

The California Licensed Resident Agent for Surety is:

(Name, address, and telephone)

. Registered Agent’s California Department of Insurance License No. .

THE CONDITION OF THIS BOND’S OBLIGATION IS THAT, if:

(1) Principal does not (a) withdraw its Bid for the period specified in the Bidding Documents, or— if no period is specified— for ninety (90) calendar days after the Bid Deadline, or within the time period as agreed to by City and Principal, or (b) attempt to withdraw its Bid when the requirements of California Public Contract Code Section 5101 et seq., or any successor legislation, are not met, then this obligation becomes null and void; or

(2) City awards Principal the Construction Contract (“Contract”) in response to Principal’s Bid, and within the time and manner specified by the Specification or Contract Documents, or— if no period is specified— within fourteen (14) calendar days after the City’s Notice of Award of the Contract, Principal (a) signs and delivers to City the Contract, in accordance with the Bid as accepted, (b) furnishes the required bonds for not only Principal’s faithful performance and proper fulfillment of the Contract, but also Principal’s payment for labor and materials used in the Project, and (c) furnishes the required insurance, then this obligation becomes null and void.

Otherwise, this Bond remains in full force and effect, and the following terms and conditions apply to this Bond:

1. Surety’s obligations under this Bond are separate, independent from, and not contingent upon any other surety’s guaranteeing that upon City’s awarding the Contract to Principal, the Principal will enter into the Contract with City.

2. No right of action accrues on this Bond to any entity other than City or its successors and assigns.

3. If an action at law or in equity is necessary to enforce or interpret this Bond’s terms, Surety must pay— in addition to the Bonded Sum— City’s reasonable attorneys’ fees and litigation costs, in an amount the court fixes.

BID FORMS

F-20

4. Surety shall mail City written notice at least 30 days before: (a) the effective date on which the Surety will cancel, terminate, or withdraw from this Bond; or (b) this Bond becomes void or unenforceable for any reason.

On the date set forth below, Principal and Surety duly executed this Bond, with the name of each party appearing below and signed by its representative(s) under the authority of its governing body.

Date:

PRINCIPAL: SURETY:

(Company Name) (Company Name)

(Signature) (Signature)

By: By:

(Name) (Name)

Its: Its:

(Title) (Title)

Address for Serving Notices or Other Documents: Address for Serving Notices or Other Documents:

EVIDENCE MUST BE ATTACHED OF THE AUTHORITY OF ANY PERSON SIGNING AS ATTORNEY-IN-FACT.

THE PRINCIPAL’S AND ATTORNEY-IN-FACT’S SIGNATURE MUST BE NOTARIZED.

A CORPORATE SEAL MUST BE IMPRESSED ON THIS FORM WHEN THE PRINCIPAL, OR THE SURETY, OR BOTH, ARE A

CORPORATION.

CORPORATE SEAL CORPORATE SEAL

BID FORMS

F-21

BOND ACKNOWLEDGMENT

FOR

SURETY’S ATTORNEY-IN-FACT

STATE OF CALIFORNIA )

) ss.

COUNTY OF )

On this day of , 20 , before me, (name), a Notary Public for said County, personally appeared (name), who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to this instrument as the attorney in fact of , and acknowledged to me that he/she subscribed the name of thereto as principal, and his/her own name as attorney in fact.

Notary Public

SEAL

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.

BIDDER’S STATEMENT OF QUALIFICATIONS

BID FORMS

F-22

1. ORGANIZATION

1.1 How many years has your organization been in business as a Contractor?

1.2 How many years has your organization been in business under its present name and

California contractor license number used for this Bid?

1.2.1 Under what other names has your organization operated?

1.3 If your organization is a corporation, answer the following:

1.3.1 Date of incorporation/organization:

1.3.2 State of incorporation/organization:

1.3.3 Corporate ID number:

1.3.4 Name of President:

1.3.5 Agent for Service of Process:

1.4 If your organization is a partnership, answer the following:

1.4.1 Date of organization/formation:

1.4.2 Type of partnership (if applicable):

1.4.3 Name(s) of general partner(s):

1.4.4 List all states in which you are registered and state ID numbers for each:

1.5 If your organization is individually owned, answer the following:

1.5.1 Date of organization:

1.5.2 Name of owner:

1.6 If the form of your organization is other than those listed above, describe it and name the principals:

2. LICENSING

2.1 List jurisdictions in which your organization is legally qualified to do business, indicate registration or license numbers, and category of license, if applicable.

2.2 List jurisdictions in which your organization’s partnership or trade name is filed.

BIDDER’S STATEMENT OF QUALIFICATIONS (continued)

BID FORMS

F-23

2.3 List any licensing suspensions and/or violations assessed against your organization within the past five years.

3. EXPERIENCE

3.1 List the categories of Work that your organization normally performs with its own personnel.

3.2 On the Experience Form (page F-32), list the project information that establishes that Bidder meets the essential requirements for qualification set forth in the Mandatory Qualifications paragraph of the Notice Inviting Bids for this Project.

3.3 Have Subcontractors for Traffic Signal and Fiber Optic Work (starting on page F-33) completed the Specialty Contractor’s Statement of Qualifications (or Bidder to complete if self-performing).

3.4 List projects to which your firm or business has been awarded a government contract since your firm or business has been in existence (giving the name and address of the project, the government agency, contact name and phone number, the contract amount, and contract’s starting date and ending date). Attach additional sheets as necessary. Failure to provide all information requested may render bid non-responsive.

3.5 List the experience and present commitments of the key individuals of your organization. Attach additional sheets as necessary. Failure to provide all information requested may render bid non-responsive.

4. CLAIMS; LAWSUITS; CRIMINAL ACTS

For the following questions, the term “owner” does not include owners of stock in your firm if your firm is a publicly traded corporation.

4.1 In the past five years, has your firm or any of its owners, partners, officers, or employees been a defendant in court, or participated in an arbitration or mediation, or administrative hearing on a matter related to:

4.1.1 The performance, non-performance, default, violation, or breach of a contract or agreement?

□ YES □ NO

BID FORMS

F-24

4.1.2 A vehicle collision or accident involving your firm’s employees?

4.1.3 Damage to real property arising out of your services or operations?

□ YES □ NO

4.1.4 Employment-related litigation brought by an employee of your firm?

□ YES □ NO

4.1.5 Payment to a subcontractor or supplier?

□ YES □ NO

4.1.6 Federal Davis Bacon or California Labor Code requirements relating to underpayment of wages, failure to maintain or produce payroll records, failure to use apprentices in appropriate ratios, or failure to maintain workers compensation insurance?

4.1.7 Defective, deficient, or substandard work?

If the answer to any question in 4.1.1 to 4.1.7 is YES, identify the name of the person or entity that sued (i.e., “the plaintiff”) or was involved in the mediation or arbitration; list the date, court, court address, and case number; describe the facts and circumstances giving rise to the lawsuit, mediation, or arbitration; and set forth the outcome or disposition. Attach additional sheets as necessary.

4.2 Has your firm ever filed a claim for damages or a lawsuit, or requested arbitration or mediation, against a government entity or a Client?

If YES, identify the government entity or client; list the date, court and case number;

describe the facts and circumstances about the claim for damages, or the lawsuit, or both;

and set forth the outcome or disposition. Attach additional sheets as necessary.

4.3 Are there any pending or outstanding judgments or liens against your firm or any of its owners, partners, officers, or employees?

BID FORMS

F-25

If YES, identify the name of the person or entity entitled to payment; list the date court and case number; describe the facts and circumstances giving rise to the judgment or lien; and set forth the amount of the judgment or lien. Attach additional sheets if necessary.

4.4 In the past five years, has any government entity ever: (a) investigated, cited, disciplined, or assessed any penalties against your firm or any of its owners, partners, officers, or employees, or (b) determined or concluded that your firm or any of its owners, partners, officers, or employees violated any laws, rules, or regulations?

If YES, identify the government entity; list the date, and describe the facts and circumstances about each instance. Attach additional sheets as necessary.

4.5 In the past five years, has your firm or any of its owners, partners, officers or employees been convicted of a crime related to the bidding of a government contract, the awarding of a government contract, or the performance of a government contract? (“Convicted” includes a verdict of guilty by a judge or jury, a plea of guilty, a plea of nolo contendere, or a forfeiture of bail.)

□ YES □ NO

If YES, identify the government entity; list the date, court and case number; describe the facts and circumstances about each instance; and set forth the penalty or punishment imposed. Attach additional sheets as necessary.

4.6 In the past five years, has your firm or any of its owners, partners, officers or employees been convicted of a crime involving embezzlement, theft, fraud, forgery, bribery, deceptive or unlawful business practices, perjury, falsifying or destroying records or evidence, or receiving stolen property, or making or submitting a false claim?

If YES, identify the crime or offense; list the date, court and case number; describe the facts and circumstances about each instance; and set forth the penalty or punishment imposed.

Attach additional sheets as necessary.

BID FORMS

F-26

4.7 Have you or, if Bidder is a corporation, any principal of the corporation ever been convicted of a felony?

If YES, explain the details of that conviction and, if so, whether you or said officer have served his or her sentence. Attach additional sheets as necessary.

4.8 In the past five years, has a government entity determined or concluded that your firm or any of its owners, partners, officers or employees made or submitted a false claim (including a false claim for payment), or made a material misrepresentation?

If YES, identify the government entity, and describe the facts and circumstances about each instance. Attach additional sheets as necessary.

4.9 Have you or your company ever been charged by any governmental agency for failure to follow safety procedures?

If YES, explain. Attach additional sheets as necessary.

4.10 Has any governmental agency ever submitted a complaint against you to the California State Labor Commission for failure to submit certified payrolls or use apprentices in proper ratios?

If YES, provide the details of such complaint. Attach additional sheets as necessary.

BID FORMS

F-27

4.11 List all Civil Wage and Penalty Assessments date and dollar amount issued against you or one of your subcontractor by any of the following entities: the California Department of Industrial Relations, a California public entity, or federal public entity, in the last five years and explain how the assessment was resolved. Attach additional sheets as necessary.

5. FIRM’S OPERATIONAL STATUS

5.1. In the past seven years, has your firm, or anyone else acting on behalf of your firm, filed for bankruptcy, insolvency, receivership, or reorganization?

If YES, list the filing date, identify the court and case number; describe the facts and circumstances giving rise to each instance; and set forth the disposition or current status.

5.2. In the past five years, has your firm had any consolidations, mergers, acquisitions, closings, layoffs or staff reductions?

□ YES □ NO

If YES, list the filing date, and describe the facts and circumstances about each instance.

5.3. Is your firm in the process of, or in negotiations toward: (a) consolidating, merging, selling, or closing its business, or (b) laying off employees or reducing staff?

If YES, describe the transaction; list the anticipated date for completing the transaction, laying off employees, or reducing staff; and describe the facts, circumstances, and reason for taking the action. Attach additional sheets as necessary.

BID FORMS

F-28

6. BIDDING; DEBARMENT; CONTRACT PERFORMANCE

6.1. Has a government entity ever debarred, disqualified, removed, suspended, or otherwise prevented your firm from bidding on, contracting, or completing a construction project?

If YES, identify the name of the government entity, list the date, and describe the facts and circumstances about each instance, and state the reason for the government entity’s action against your firm. Attach additional sheets as necessary.

6.2. Has a government entity ever rejected your firm’s Bid or Proposal on the ground that your firm is a “non-responsible” bidder or proposer?

If YES, identify the name of the government entity, list the date, describe the facts and circumstances about each instance, and state the reason or basis for the government entity’s determining that your firm was a “non-responsible” bidder. Attach additional sheets as necessary.

6.3. Has your firm ever failed to fulfill or perform – either partially or completely – a contract or an agreement with a government entity or a client?

If YES, identify the name of the government entity or client, list the date, and describe the facts and circumstances about each instance. Attach additional sheets as necessary.

6.4. In the past five years, has any officer or principal of your firm been an officer of another firm which failed to perform a contract or agreement?

If YES, list the date, and describe the facts and circumstances about each instance. Attach

BID FORMS

F-29

6.5. Has your firm ever advised a government entity or a client, while your firm was under contract with the government entity or client, that your firm could not (or would not) fulfill or perform – either partially or completely – the contract or the agreement based on the prices that your firm had originally submitted in a Bid or a Proposal?

If YES, list the date, identify the name of the government entity or client, and describe the

6.6. Has your firm ever requested a government entity or a client, while your firm was under contract with the government entity or client, to renegotiate one or more terms of the existing contract or agreement?

6.7. Has your firm ever requested a government entity or a client, while your firm was under contract with the government entity or client, to: (a) cancel the contract or agreement, or

(b) release or discharge your firm form the contract or agreement?

□ YES □ NO

6.8. Has a government entity or a client ever terminated, suspended, or non-renewed your firm’s contract or agreement before its completion?

If YES, identify the name of the government entity, list the date, and describe the facts and circumstances about each instance. Attach additional sheets as necessary.

BID FORMS

F-30

6.9. Has a government entity or a client ever notified or advised your firm that your firm’s performance under a contract or agreement was poor, sub-standard, deficient, or non-compliant?

6.10. In the past five years, has your firm paid, or has your firm been assessed, liquidated damages on a contract or agreement?

If YES, identify all such contracts/projects by owner, owner’s address, the date of completion of the project, amount of liquidated damages assessed, and all other information necessary to fully explain the assessment or payment of liquidated damages. Attach

7. INSURANCE AND BONDS

7.1. In the past ten years, has an insurance company or a surety company:

7.1.1. Refused to insure your firm for liability coverage?

7.1.2. Canceled or non-renewed your firm’s insurance coverage?

□ YES □ NO

7.1.3. Refused to issue your firm a bond?

□ YES □ NO

7.1.4. Canceled or revoked a bond obtained by your firm?

If the answer to any question in 7.1.1 to 7.1.4 is YES, identify the name of the insurance company or surety company, list the date, and describe the facts and circumstances about each instance. Attach addition sheets as necessary.

BID FORMS

F-31

7.2 In the past ten (10) years, has an insurance company or surety company made any payments on your firm’s behalf as a result of a default, to satisfy any claims against a performance bond, payment bond, or maintenance bond issued on your firm’s behalf?

□ YES □ NO

If YES, identify each contract completed or amount of each claim, the name and telephone number of the claimant, the date, grounds and current status of the claim, and if resolved, the method, nature, and amount of the resolution. Attach addition sheets as necessary.

8. SURETY

8.1 If a performance and/or payment bond is required by this bid, identify the bonding company if arrangements for the bond have been made; if not, identify the bonding company for the Contractor’s most recent project:

8.2 Name and address of agent:

I, the undersigned, certify and declare that I have read all the foregoing answers to the questionnaire and know the contents. The matters stated in the questionnaire answers are true of my own knowledge and belief, except as to those matters stated on information and belief, and as to those matters I believe them to be true. I declare under penalty of perjury under the laws of the State of California, that the foregoing is correct and that this declaration is executed on , at , .

Date City State

By:

Name:

Printed

Title:

Printed

[END OF DOCUMENT]

Specification No. 3829R

BID FORMS/EXPERIENCE FORM

F-32

EXPERIENCE FORM

PROJECT NAME: La Crescenta Avenue Rehabilitation Project SPECIFICATION NO. 3829R

COMPANY NAME:

***Please use additional sheets if necessary

List below the project information that establishes that Bidder meets the essential requirements for qualification set forth in the Mandatory Qualifications paragraph of the Notice Inviting Bids for this Project.

CONTRACT

START DATE

CONTRACT

END DATE

CONTRACT

$ AMOUNT PROJECT NAME ADDRESS CONTACT NAME

CONTACT PHONE

NUMBER

SPECIALTY CONTRACTOR’S STATEMENT OF QUALIFICATIONS - ETA

Specification No. 3829R

BID FORMS

SPECIALTY CONTRACTOR’S STATEMENT OF

QUALIFICATIONS – ETA

FORM

F-33

FIBER OPTIC CONDUIT AND CABLE INSTALLATION REQUIREMENT

As part of its Bid, Bidder shall submit this Statement of Qualifications for the Subcontractor that will perform FIBER OPTIC CONDUIT AND CABLE INSTALLATION work, or for the Bidder itself, if Bidder will self-perform the FIBER OPTIC CONDUIT AND CABLE INSTALLATION work. This information shall provide evidence to indicate successful experience in providing FIBER OPTIC CONDUIT AND CABLE INSTALLATION work comparable to that specified in the Project Drawings and Specifications. Referenced qualifications shall demonstrate experience as a successful installer of FIBER OPTIC CONDUIT AND CABLE INSTALLATION work.

A Bid may be rejected as non-responsive if Bidder fails to provide this completed form with the Bid or submits this form with inaccurate information.

Mandatory qualifications: Specialty Contractor (or Bidder, if self-performing) shall possess a valid Electronics Technicians Association (ETA), Inc. certification at the time of the Bid Deadline and at all times during performance of the Work and shall establish that it satisfactorily completed at least four (4) projects as the installer of Intelligent Transportation System (ITS) communications related outdoor fiber optic installation projects with at least 5,000 fiber optic terminations and at least 5,000 field splices (fusion and mechanical); each comparable in scope and complexity to this Project, within five (5) years prior to the Bid Deadline. Note: The CONTRACTOR’s employee(s) performing fiber optic termination and testing services shall be trained and certified as either Certified Fiber Optic Installer (CFOI) or Certified Fiber Optic Technician (CFOT) by the ETA at the time of BID submittal. For an employee to be considered experienced and qualified, the employee shall provide evidence for performing at least 5,000 connections, performing at least 5,000 fiber connection tests with an Optical Time Domain Reflectometer (OTDR), and performing at least 5,000 end-to-end attenuation tests. The CONTRACTOR shall provide names of employees meeting these requirements as part of their

BID.

Specialty Contractor Name:

Contractor License No:

ETA Certification No. and Date:

Employee Performing Termination and Testing Services:

Certification Name & Number: Certification Date:

Employee Performing Termination and Testing Services:

Certification Name & Number: Certification Date:

Employee Performing Termination and Testing Services:

Certification Name & Number: Certification Date:

COMPARABLE PROJECTS (Provide at least four (4))

1. Project Name:

Address:

Date Completed:

Reference / Contact Name:

SPECIALTY CONTRACTOR’S STATEMENT OF QUALIFICATIONS - ETA

Specification No. 3829R

BID FORMS

SPECIALTY CONTRACTOR’S STATEMENT OF

QUALIFICATIONS – ETA

F-34

Reference / Contact Phone No:

Description of work performed:

2. Project Name:

3. Project Name:

4. Project Name:

SPECIALTY CONTRACTOR’S STATEMENT OF QUALIFICATIONS - IMSA

Specification No. 3829R

BID FORMS

SPECIALTY CONTRACTOR’S STATEMENT OF

QUALIFICATIONS – IMSA

F-35

TRAFFIC SIGNAL CABINET/EQUIPMENT &

VIDEO DETECTION SYSTEM REQUIREMENT

As part of its Bid, Bidder shall submit this Statement of Qualifications for the Subcontractor that will perform TRAFFIC SIGNAL CABINET/EQUIPMENT AND VIDEO DETECTION SYSTEM work, or for the Bidder itself, if Bidder will self-perform the TRAFFIC SIGNAL CABINET/EQUIPMENT AND VIDEO DETECTION SYSTEM work. This information shall provide evidence to indicate successful experience in providing TRAFFIC SIGNAL CABINET/EQUIPMENT AND VIDEO DETECTION SYSTEM work comparable to that specified in the Project Drawings and Specifications. Referenced qualifications shall demonstrate experience as a successful installer of TRAFFIC SIGNAL CABINET/EQUIPMENT AND VIDEO DETECTION SYSTEM work.

A Bid may be rejected as non-responsive if Bidder fails to provide this completed form with the Bid or submits this form with inaccurate information.

Mandatory qualifications: Specialty Contractor (or Bidder, if self-performing) shall possess at least one valid International Municipal Signal Association (IMSA) Traffic Signal Field Technician Level II or Senior Field Technician Level III certification at the time of the Bid Deadline and at all times during performance of the Work within traffic signal cabinets, video detection systems, and related traffic signal equipment.

The CONTRACTOR shall provide names of employees meeting these requirements as part of their BID.

Specialty Contractor Name:

Contractor License No:

Employee Performing Services:

IMSA Certification No.: Certification Date:

Employee Performing Services:

IMSA Certification No.: Certification Date:

Employee Performing Services:

IMSA Certification No.: Certification Date:

Specialty Contractor Name:

Contractor License No:

Employee Performing Services:

IMSA Certification No.: Certification Date:

Employee Performing Services:

IMSA Certification No.: Certification Date:

Employee Performing Services:

IMSA Certification No.: Certification Date:

CONTRACTOR’S REFERENCES – ALL PROJECTS

Specification No. 3829R

BID FORMS

CONTRACTOR’S REFERENCES – ALL PROJECTS FORM

F-36

Please provide a list of at least three (3) different agencies or companies for whom you have completed projects in the past five (5) years as a prime contractor. Each project must have all of the following: 1) a minimum of three (3) traffic signals; 2) a minimum total contract amount of $5,000,000; 3) work related to new or upgrade of sewer; and 4) work related to traffic signals (conduits, cabinets, foundations, signal heads, and electrical wiring), and street improvements (curb ramps and sidewalk).

Contact Person Name of Agency or Company Name and Year of Project Scope of Work Address Telephone No.

Total Contract Amount Traffic Signal Contract Amount Curb ramp/sidewalk Contract Amount

Contact Person Name of Agency or Company Name and Year of Project Scope of Work Address Telephone No.

Total Contract Amount Traffic Signal Contract Amount Curb ramp/sidewalk Contract Amount

Contact Person Name of Agency or Company Name and Year of Project Scope of Work Address Telephone No.

Total Contract Amount Traffic Signal Contract Amount Curb ramp/sidewalk Contract Amount

CONTRACTOR SAFETY QUESTIONNAIRE

BID FORMS

F-37

Company Name: ____________________________________________________________________________

Primary Type of Work:…