BURLINGAME TOWN SQUARE PAVER SEALING

Proposal

GENERAL

Burlingame Town Square Paver Sealing

, 20

TO THE CITY OF BURLINGAME, CALIFORNIA:

Pursuant to the foregoing Notice to Contractors, the undersigned bidder has reviewed and examined the Request for Proposal (RFP), and any addenda in their entirety, and hereby states that the firm is qualified to construct the project. The bidder herewith submits its proposal on the Bid Form, Designation of Subcontractors, and Statement of Experience Qualifications, Non-Collusion Declaration, and Statement under Public Contract Code Section 10285.1 attached hereto and made a part hereof, and binds itself on award by the City of Burlingame under this proposal to execute in accordance with such award, a contract, of which this Proposal and the Notice to Contractors, Instructions to Bidders, Special Provisions, Standard Specifications, and Plans and Specifications are hereby made a part of this Proposal and all provisions thereof are hereby accepted.

In submitting this proposal, the bidder has confirmed the existence of any and all addenda and accepts the changes to the contract included in all addenda. The bidder shall include specific acknowledgement in the space provided of receipt of all addenda issued during the bidding period.

The bidder further agrees that in case of its default in executing the Contract Documents, and providing the required bonds and insurance, the cash, check or Bidder's Bond, accompanying its proposal and the money payable thereon shall be and remain the property of the City of Burlingame, as provided in the Instructions to Bidders and the Special Provisions.

Company name:

(Corporate Seal)

Signature

Address

Contractor’s license number:

Contractor’s telephone no.

Contractor’s facsimile no.

If a corporation, organized under the laws of the state of: , Nature of firm (corporation, partnership, etc.) and names of individual members of the firms, or names and titles of officers of the corporation:

Name Title

DESIGNATION OF SUBCONTRACTORS

(Public Contract Code Sections 4100 et seq.)

TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID PROPOSAL

As a bidder on the above-entitled project, the undersigned hereby designates the subcontractors that will perform work or labor or render services to the Contractor in or about the construction of the project in an amount in excess of one-half (1/2) of one percent (1%) of the Contractor's total bid or $10,000 whichever is greater.

The undersigned understands and agrees that should it fail to specify a subcontractor for any portion of the work as above stated, it agrees that the undersigned is fully qualified to perform that portion of the work itself, and that it shall perform that portion itself. Penalties for failure to comply with this provision are provided in the Subletting and Subcontracting Fair Practices Act commencing with Section 4100 of the Public Contract Code.

Pursuant to Public Contract Code Section 6109, Contractor shall not allow or permit any subcontractor that is ineligible to perform work on a public works project pursuant to Labor Code Section 1777.1 or 1777.7, to perform any work on this Project.

The undersigned agrees that it shall not, without written consent of the City Council, make any substitution, assignment or sublet to or of the following list of subcontractors which is made a part of this proposal and then only after compliance with the provisions of the Subletting and Subcontracting Fair Practices Act. [ATTACH ADDITIONAL PAGES IF NECESSARY]

LIST OF SUBCONTRACTORS

NAME OF

SUBCONTRACTOR

ADDRESS OF

SUBCONTRACTOR

STATE

CONTRACTORS

LICENSE #

DIR

REGISTRATION

WORK TO BE DONE BY

SUBCONTRACTOR

NAME OF BIDDER:

Signature: ____________________________________________

STATEMENT OF EXPERIENCE QUALIFICATIONS

The following statement as to experience qualifications of the bidder is submitted in conjunction with the Proposal, as a part thereof, and the truthfulness and accuracy of the information is guaranteed by the Bidder.

The bidder has been engaged in the contracting business, under the present business name, For five (5) years. Experience in work of a nature similar to that covered in the proposal extends over a period of five (5) years

The bidder, as a contractor, has never failed to satisfactorily complete a contract awarded to it, except as follows:

The following contracts have been satisfactorily completed in the last three years for the persons, firm or authority indicated, and to whom reference is made:

YEAR TYPE OF WORK

PROJECT NAME

CONTRACT

AMOUNT LOCATION

FOR WHOM

PERFORMED

CONTACT

NAME

AND PHONE NO.

NAME OF BIDDER:

Signature:

NON-COLLUSION DECLARATION

(PUBLIC CONTRACT CODE SECTION 7106)

I, , declare under penalty of perjury that I am (sole owner, partner, president, etc.) of , 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 or 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 thereof to effectuate a collusive or sham bid.

I declare under penalty of perjury that the foregoing is true and correct and this was executed on the date shown below at __________________________________.

(City, State)

Dated: _____________________

NAME OF BIDDER: ____________________________

Signature ______________________________________

PUBLIC CONTRACT CODE SECTION 10285.1 STATEMENT

TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID

In accordance with Public Contract Code Section 10285.1 (Stats. 1985, Ch. 376), the bidder hereby declares under penalty of perjury under the laws of the State of California that the bidder has_____, has not _____ been convicted within the preceding three years of any offenses referred to in that section, including any charge of fraud, bribery, collusion, conspiracy, or any other act in violation of any state or federal antitrust law in connection with the bidding upon, award of, or performance of, any public works contract, as defined in Public Contract Code Section 1101, with any public entity, as defined in Public Contract Code Section 1100, including the Regents of the University of California or the Trustees of the California State University. The term "bidder" is understood to include any partner, member, officer, director, responsible managing officer, or responsible managing employee thereof, as referred to in Section 10285.1.

[NOTE: THE BIDDER MUST PLACE A CHECK MARK AFTER "HAS" OR "HAS NOT"

IN ONE OF THE BLANK SPACES ABOVE.]

The above Statement is part of the Proposal. Bidders are warned that making a false certification may subject the certifier to criminal prosecution.

I declare under penalty of perjury that the foregoing is true and correct and this was executed on the date shown below at __________________________________.

(City, State)

Dated: ______________________

PUBLIC CONTRACT CODE SECTION 10162 QUESTIONNAIRE

In accordance with Public Contract Code Section 10162, the Bidder shall complete, under penalty of perjury, the following questionnaire:

Has the bidder, any officer of the bidder, or any employee of the bidder who has a proprietary interest in the bidder, ever been disqualified, removed, or otherwise prevented from bidding on, or completing a federal, state, or local government project because of a violation of law or a safety regulation?

No___________ Yes___________

If the answer is yes, explain the circumstances below:

I declare under penalty of perjury that the foregoing is true and correct and this was executed on the date shown below at __________________________________.

(City, State)

Dated: ______________________

Public Contract Code 10232 Statement

In accordance with Public Contract Code Section 10232, the Contractor, hereby states under penalty of perjury, that no more than one final unappealable finding of contempt of court by a federal court has been issued against the Contractor within the immediately preceding two year period because of the Contractor’s failure to comply with an order of a federal court which orders the Contractor to comply with an order of the National Labor Relations Board.

Note: The above Statement and Questionnaire are part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Statement and Questionnaire. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution.

I declare under penalty of perjury that the foregoing is true and correct and this was executed on the date shown below at __________________________________.

(City, State)

Dated: ______________________

POWER OF ATTORNEY

KNOW ALL PERSONS BY THESE PRESENTS. That constituting all of the (general partners/venturers) of the (partnership/joint venture) known as which is desirous of entering into a contract with the City of Burlingame, do hereby designate and appoint one of the (general partners/venturers) hereinafter called the “Managing Sponsor,” as their true and lawful attorney with the power, on their behalf and in the name and on behalf of the (partnership/joint venture), to execute a proposal for and to execute and enter into Contract for Burlingame Town Square Paver

Sealing with the City of Burlingame, and to represent and bind the undersigned and the

(partnership/joint venture), in all matters in connection with such proposal and contract; and the undersigned specifically acknowledge and agree that the execution of such proposal or contract by the Managing Sponsor shall constitute the agreement of each (general partner/venturer) to be jointly and severally liable for any and all of the duties and obligations of the (partnership/joint venture) arising from such proposal or contract.

IN WITNESS WHEREOF the undersigned have executed this Power of Attorney this day of , 2026.

Dated: ______________________

CERTIFICATE CONCERNING CONTROL OF EMPLOYEE

The Contractor, by entering into this Contract with Burlingame to perform or provide work, services, or materials to Burlingame, does hereby certify and assure that in performing the services under this

Contract, the Contractor shall act as an independent Contractor and shall have full control of the work and Contractors employees. Contractor and its employees in no circumstances whatsoever shall imply or be considered as an agent(s) or employee(s) of Burlingame. Contractor or a Subcontractor employee in no circumstances shall be entitled to part of any pension plan, insurance, bonus or any similar benefits which Burlingame provides its own employees. Should a court award Contractor’s employees or a Subcontractor’s employees, any such pension employees plan, insurance, bonus or any similar benefits which Burlingame provides its own employees, then Contractor shall pay all costs associated with such an award.

Any violation of the provisions of this Certification shall be cause for termination of the Contract.

Dated: ______________________

CERTIFICATE REGARDING WORKERS COMPENSATION

Contract with the CITY OF BURLINGAME, 501 Primrose Rd., Burlingame, California

94010, for:

BURLINGAME TOWN SQUARE PAVER SEALING

Contract No. (TBD by CITY)________________

Labor Code Section 3700:

“Every employer, except the State, and all political subdivisions or institutions thereof, shall secure the payment of compensation in one or more of the following ways:

(a) By being insured against liability to pay compensation by one or more insurers, duly authorized to write compensation insurance in this State.

(b) By securing from the Director of Industrial Relations a certificate on consent to self-insure, which may be given upon furnishing proof satisfactory to the Director of Industrial

Relations of ability to self-insure and to pay any compensation that may become due to employees.”

I am aware of the provisions of Section 3700 of the Labor Code, which require every employer to be insured against liability for worker's compensation or to undertake self-insurance. In accordance with the provisions of that code, I will comply with such provisions before commencing the performance of the work of this contract.

Dated: ______________________

NAME OF BIDDER: ____________________________

Signature ______________________________________

(Labor Code Section 1861, provides that the above certificate must be signed and filed by the Contractor with the Authority prior to performing any work under this contract.)