Bid Notice.pdf

VOLUME 5 – SAMPLE BID BOOK

(FOR INFORMATION PURPOSES ONLY)

for Richmond Street Complete Streets Project

In Contra Costa County, California

Date Advertised: 9/2/2026 Bid Opening Date: 9/24/2026 @ 2:00PM

Identified by:

CCTA Solicitation No.: IFB 26-C4 CCTA Contract No.: 774 CCTA Project No.: 31004

Federal Aid No.: SS4AL-6072(047)

Under

Bid Book Dated: 9/2/2026 Notice to Bidders and Special Provisions Dated: 9/2/2026

Project Plans Approved: 9/2/2026 Caltrans Standard Specifications 2025 Edition

Caltrans Standard Plans 2025 Edition

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FORMS TO BE SUBMITTED AT TIME OF BID

The following forms must be submitted with the bid in the form provided with this solicitation. Other than changes necessary to complete the forms, bidders shall not otherwise alter or modify the forms. Any bidder who makes such alterations or modifications may be disqualified or its bid rejected as nonresponsive.

1. Bid Form

2. Bidder’s Bond

3. Subcontractor Listing

4. Equal Employment Opportunity Certification

5. Public Contract Code Section 10285.1 Statement

6. Public Contract Code Section 10162 Questionnaire

7. Public Contract Code 10232 Statement

8. Noncollusion Affidavit

9. Debarment and Suspension Certification

10. Bidders Certificate of Compliance Regarding Workers Compensation Insurance

11. Declaration Re Non-Disciplinary or Investigatory Action

12. Certificate of Compliance with Insurance Requirements

13. Statement of Ability to Obtain Bonding

14. Contractor Questionnaire

15. Public Works Contractor Registration Certification

16. Iran Contracting Act of 2010 Certification Form

17. Buy America Certificate

18. Nonlobbying Certification for Federal-Aid Contracts

19. Bidder’s/Proposer’s List For

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BID FORM

CONSTRUCTION OF

[NAME OF PROJECT] PROJECT

IN THE COUNTY OF CONTRA COSTA, CALIFORNIA

CONTRACT NO. ______________

Name of Bidder: ___________________________________________________ Business P.O. Box: ___________________________________________________ Business Street Address: ___________________________________________________ City, State, Zip: ___________________________________________________ Telephone No.: ___________________________________________________ Fax No.: ___________________________________________________ Date: ___________________________________________________ Contractor’s License Number / Classification / Exp. Date

Contractor’s California DIR Registration Number

This bid is submitted for the work that is being solicited by the Contra Costa Transportation Authority (“Authority”) pursuant to IFB No. _________ for the ______________________ Project, as more fully described in the Contract Documents identified in Article 1 of the Contract Articles for the Project.

The undersigned has provided security for its bid by means of cashier’s check, certified check, or “bidder’s bond” (Circle applicable term as the case may be), in an amount equal to ten percent (10%) of the total bid amount, for the sum of __________________________ Dollars ($___________________). Where a cashier’s check or certified check was provided, the check was made payable the CONTRA COSTA TRANSPORTATION AUTHORITY, and was delivered to the Authority to the Attention of the Contract Manager at the Authority's principal office at 2999 Oak Road, Suite 100, Walnut Creek, CA 94597, before or at the time the bid was submitted. If a bond bind was supplied, it was submitted with and at the time of the bid.

If a cashier’s check or certified check accompanied this bid as the guarantee, then the proceeds thereof shall become the property of the Contra Costa Transportation Authority if, in the case this bid is accepted by the Board of Contra Costa Transportation Authority or Authorized Representative and such bidder has received a Notice of Award issued by the Authority, the undersigned shall fail within ten (10) business days, not including Saturdays, Sundays and legal holidays, thereafter to execute a Contract with the Authority and furnish the payment bond, performance bond and insurance certificates required by the Contract Documents. Otherwise, such guarantee shall be returned to the undersigned.

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Bid Form IFB No. ___________

The undersigned hereby acknowledges the following:

1. The solicitation and all related Contract Documents for the Project are for the work to be done entitled:

[IFB NO.________] [PROJECT NAME] PROJECT IN THE COUNTY OF CONTRA COSTA, CALIFORNIA

If addenda are issued, this bid is submitted with respect to the changes to the solicitation documents included in the Addenda issued. Bidder further acknowledges the receipt of the following Addenda Number(s): insert number(s) , _____, _____, . [List all addenda.]

2. The bidder represents and acknowledges that it has thoroughly reviewed the requirements of this solicitation, including all documents, contractual requirements, plans and specifications, and has become familiar with the work identified in this solicitation. Bidder also acknowledges that it is satisfied with the general and local conditions to be encountered; the character, quality, and scope of work to be performed; quantities and types of materials to be furnished;

and character, quality, and quantity of surface and subsurface materials or obstacles.

3. The bidder represents and warrants that it has no knowledge of any conflict, inconsistency, ambiguity, or other apparent discrepancy in the Contract Documents other than those which the Contractor has notified the Authority by submitting questions and/or clarifications to this solicitation.

4. Bidder fully understands the scope of the work and specifications identified in the solicitation and all Contract Documents, has carefully checked all words and figures inserted in this bid, and further understands that the Authority will not be liable for any errors or omissions in the preparation of this bid.

5. Bids are required for the entire work. The amount of the bid for comparison purposes will be the total of all items. The total of unit basis items will be determined by extension of the item price bid on the basis of the estimated quantity set for the item.

6. The bidder shall set forth for each unit basis item of work a unit price and a total for the item, and for each lump sum item a total for the item, all in clearly legible figures in the respective spaces provided for that purpose. In the case of unit basis items, the amount set forth under the “Item Total” column shall be the product of the unit price bid and the estimated quantity for the item.

7. It is understood and agreed that the quantities of work under each item are approximate only, being given for a basis of comparison of proposal, and the right is reserved to the Authority to increase or decrease the amount of work under any item as may be required, in accordance with provisions set forth in the specifications for this project.

8. In case of discrepancy between the unit price and the total set forth for a unit basis item, the unit price shall prevail, except as provided in (a) or (b) as follows:

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(a) If the amount set forth as a unit price is unreadable or otherwise unclear, or is omitted, or is the same as the amount of the entry in the item total column, then the amount set forth in the item total column for the item shall prevail and shall be divided by the estimated quantity for the item and the price thus obtained shall be the unit price;

(b) (Decimal errors) If the product of the entered unit price and the estimated quantity is exactly off by a factor of ten, one hundred, etc., or one-tenth, one-hundredth, etc., from the entered total, the discrepancy will be resolved using the entered unit price or item total, whichever most closely approximates percentage-wise the unit price or item total in Authority’s final estimate of cost.

If both the unit price and the item total are unreadable or otherwise unclear, or are omitted, the bid may be deemed irregular. Likewise, if the item total for a lump sum item is unreadable or otherwise unclear, or is omitted, the bid may be deemed irregular unless the project being bid has only a single item and a clear, readable total bid is provided.

Symbols such as commas and dollar signs will be ignored and have no mathematical significance in establishing any unit price or item total or lump sums. Written unit prices, item totals, and lump sums will be interpreted according to the number or digits and, if applicable, decimal placement. Cents symbols also have no significance in establishing any unit price or item total, since all figures are assumed to be expressed in dollars and/or decimal fractions of a dollar. Bids on lump sum items shall be item totals only; if any unit price for a lump sum item is included in a bid and it differs from the item total, the item’s total shall prevail.

The foregoing provisions for the resolution of specific irregularities cannot be so comprehensive as to cover every omission, inconsistency, error, or other irregularity which may occur in a bid.

Any situation not specifically provided for will be determined in the discretion of the Authority, and that discretion will be exercised in the manner deemed by the Authority to best protect the public interest in the prompt and economical completion of the work. The decision of the Authority respecting the amount of a bid or the existence or treatment of an irregularity in a bid shall be final.

9. The undersigned, as bidder, declares that the only persons or parties interested in this Bid as principals are those named herein; that this bid is made without collusion with any other person, firm or corporation; that the bidder has carefully examined the location of the proposed work, the contract, any addenda issued, and the plans referred to herein, having become thoroughly familiar with the terms and conditions of the Contract Documents and with the local conditions affecting the performance and cost of the work at the place where the Work is to be done; and the bidder agrees if this bid is accepted, that the bidder will contract with the Authority, in the form of the copy of the Contract annexed hereto, to provide all necessary labor, machinery, tools, apparatus, and other means of construction, and to do all the work and furnish all the materials specified in the Contract Documents, in the manner and time therein prescribed, and in accordance with the requirements set forth therein, and that the bidder will accept as full payment therefore the following prices, to wit:

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The Bid Items List Is Located on www.bidexpress.com. Excel or other files will not be accepted. Bids must be entered into www.bidexpress.com.

Bids must include prices for all bid items. For a bid with no Alternate Bid Items, the lowest bid will be determined from the total of all bid items. For a bid with Alternate Bid Items, the lowest bid will be determined from the Base Bid plus the Alternate Bid Items identified in the Bid Item List. For unit-price bid items, the total price of each item will be determined by multiplying the unit price bid by the estimated quantity shown for the item.

If the Contract is awarded, it will be awarded to the responsible bidder submitting the responsive lowest bid, as determined above. After the lowest responsible bidder has been determined, the Authority may award the Base Bid with any, all, or none of the Alternate Bid Items. The Contract amount will be the total of the bid items included in the award.

Bid prices include all labor, materials, taxes, licenses, shipping, testing, warranties, setup, equipment, and incidentals necessary to complete the Work.

10. Bidder understands that the Authority reserves the right to reject the bid, and that the bid shall remain open and not withdrawn for a period of ninety (90) calendar days from the date of the bid opening. The award of the contract will be subject to the availability of funds. The Authority reserves the right, in its sole discretion, to investigate your qualifications, require confirmation of information furnished by you, require additional evidence of qualifications, cancel this procurement, reject any or all bids and waive any irregularities in the bidding in addition to any other rights the Authority may have under the Contract documents.

11. Bidder hereby certifies that he/she has reviewed the insurance coverage requirements specified in the Contract. Should he/she be awarded the contract for the work, bidder further certifies that he/she can meet all Contract requirements for insurance including insurance coverage of his/her subcontractors. Bidder certifies that they are aware of the provisions of Section 3700 of the Labor Code which requires every employer to be insured against liability for worker’s compensation or to undertake self-insurance in accordance with the provisions of that code, and bidder will comply with such provisions before commencing the performance of the work of this contract.

12. Bidder hereby lists the names of all persons interested in the forgoing bid as principals and are as follows:

IMPORTANT NOTICE: If bidder or other interested person is a corporation, state legal name of corporation, and names of the president, secretary, treasurer, and manager thereof authorized to execute this bid; if an limited liability corporation, state the legal name of the LLC, and the names of the managers authorized to execute this bid; if a partnership or joint venture, state true name of firm, and names of all individual partners or joint venturers comprising the firm; if bidder or other interested person is an individual, state first and last names in full.

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13. Bidder has attached hereto and incorporated herein the complete and entire list of subcontractors to be employed by the undersigned in the performance of the work.

14. Bidder has executed and submitted with this Bid all forms required by the solicitation. (If the bidder has submitted bid security other than a bid bond, the bid bond need not be executed or submitted.)

15. Bidder certifies under penalty of perjury under the laws of the State of California, that the statements within the foregoing bid, including, without limitation, the questionnaire and statements provided for in the forms accompanying this solicitation are true and correct. By my signature on this bid, I further certify, under penalty of perjury of the laws of the State of California and the United States of America, that the Non-collusion Declaration required under California Public Contract Code section 7106 is true and correct.

This declaration executed in California, at (place) ___________________ on (date) _____________

Bid and Certification submitted by _________________________________________________________ Bidder Name

Business Type (check only one): [ ] Corporation [ ] Partnership [ ] Sole Proprietorship [ ] Limited Liability Company [ ] Joint Venture* [ ] Other ____________________________

SIGN HERE

Signature of Authorized Representative of Bidder

Print Name and Title

Note: If the bidder is a corporation, the legal name of the corporation shall be set forth above with the signature of the officer authorized to sign contracts on behalf of the corporation and such officer shall be authorized by bylaw or resolution of the corporation to do so and the bylaw or resolution provided to the Authority prior to the opening of bids bid. If bidder is a limited liability company, the name of the LLC and authorized manager shall be stated. If a partnership or joint venture, the true name of the firm shall be set forth above together with the signature of the partner or joint venturer authorized to sign contracts in behalf of the partnership or joint venture. If a bidder is an individual, his signature shall be placed above. If signature is by an agent, other than an officer of a corporation or member of a partnership or joint venture, a Power of Attorney must be on file with the Authority prior to opening of the bids or submitted with the bid; otherwise, the bid will be disregarded as irregular and found non-responsive.

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*If the bidder is a joint venture, furnish a letter from each joint venture member firm stating that the respective member firm agrees to be held jointly and severally liable for any and all duties and obligations of the Bidder under the proposal and under any contract arising therefrom.

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BIDDER’S BOND

IFB No.:_________ Project No.:_____________ Project Name: ____________________________________

KNOW ALL PERSONS BY THESE PRESENTS:

That, (bidder’s name) as principal and bidder (hereafter “Principal”), and (surety company) (hereafter “Surety”), as surety for this bond, provide this forfeiture bond to Contra Costa Transportation Authority (hereafter “Owner”) as beneficiary. Surety shall be an admitted surety insurer as defined in section

995.120 of the California Code of Civil Procedure.

Principal and Surety are firmly bound unto the Owner in the penal sum of ten percent (10%) of the total aggregate amount of the bid of the above contractor (hereafter “Penal Sum”), submitted by said Principal to Owner for the work described in the Notice to Bidders, for the payment of which sum in lawful money of the United States, well and truly to be made, Principal and Surety bind ourselves, our heirs, executors, administrators, and successors, and assigns, jointly and severally, firmly by these presents. The Penal Sum shall be forfeited in its entirety to Owner, without consideration as to the amount of actual damages incurred by Owner, if Principal fails to enter into the contract for the work described in the Notice to Bidders or fails to furnish the necessary performance and payment bonds and insurance. A Bid Bond has been submitted by Principal to Owner and delivered to and received by Contra Costa Transportation Authority located at 2999 Oak Road, Suite 100, Walnut Creek, CA 94597.

(Remainder of Page Intentionally Left Blank)

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IN WITNESS WHEREOF, we have hereunto set our hands and seals this _______ day of ______________, 20________.

CONTRACTOR/PRINCIPAL:

Name

By:_______________________________________

SURETY:

By: ______________________________________ Attorney-In-Fact

Signatures of those signing for the Contractor and Surety must be notarized and evidence of corporate authority attached. Notary is not applicable for electronic bonding.

The rate of premium on this bond is ____________ per thousand. The total amount of premium charges, $_______________________ (not used for bid bonds).

(The above must be filled in by Attorney-In-Fact.)

THIS IS A REQUIRED FORM

Any claims under this bond may be addressed to: _____________________________________________ (Name and Address of Surety)

(Name and Address of Agent or _____________________________________________ Representative for service of process in California, if different from above) _____________________________________________

(Telephone number of Surety and Agent or _____________________________________________ Representative for service of process in California)

NOTE: A copy of the Power of Attorney to local representatives of the bonding company must be attached hereto.

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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 ____________ )

On ____________________, before me, ____________________________, Notary Public, personally appeared _______________________________, 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 laws of the State of California that the foregoing paragraph is true and correct.

WITNESS my hand and official seal.

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SUBCONTRACTOR LISTING

Pursuant to California Public Contract Code section 4104, the bidder shall identify the following in their bid:

A. The name, location of place of business, California contractor license number and public works contractor registration number issued pursuant to Labor Code Section 1725.5 of each subcontractor performing work or rendering a service to the bidder, including trucking which shall be listed as subcontracted work, in an amount in excess of one-half of one percent of the total bid amount, or $10,000, whichever is greater; and B. Show the portion of work by bid item number, description and percentage of each bid item subcontracted.

The bidder shall list only one subcontractor for each portion of work as identified in its bid and shall complete and submit the subcontractor listing form presented in this solicitation package as part of their bid. If the bidder is not proposing to use subcontractors, or the portion of the work is less than ½ of 1%, or $10,000, the bidder is to acknowledge the subcontractor listing form in this solicitation with “Not Applicable”.

The bidder shall complete the form entitled "Listing of Subcontractors" contained in this solicitation. The form must be completed and submitted with the bid.

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The Bidder must list the name and address, Contractor license number, and description of portion of work subcontracted of each subcontractor to whom the Bidder proposes to subcontract portions of the work, as required by the provisions of the Standard Specifications and of the special provisions.

LIST OF SUBCONTRACTORS

Business

Name and Location

California Contractor

License Number

Contractor Division of Industrial Relations

Registration Number

Description of Portion of Work

Bid Items Numbers

Percentage of Bid Item

Subcontracted

(THE BIDDER'S EXECUTION ON THE SIGNATURE PORTION OF THIS PROPOSAL

CONSTITUTES AN ENDORSEMENT AND EXECUTION OF THOSE CERTIFICATIONS WHICH

ARE A PART OF THIS PROPOSAL)

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EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION

The bidder , proposed subcontractor

, hereby certifies that the subcontractor 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, the subcontractor 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.

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PUBLIC CONTRACT CODE

PUBLIC CONTRACT CODE SECTION 10285.1 STATEMENT

In conformance with Public Contract Code Section 10285.1 (Chapter 376, Stats. 1985), the bidder hereby declares under penalty of perjury under the laws of the State of California that the bidder has , has not been convicted within the preceding three years of any offenses referred to in that section, including any charge of fraud, bribery, collusion, conspiracy, or any other act in violation of any state or Federal antitrust law in connection with the bidding upon, award of, or performance of, any public works contract, as defined in Public Contract Code Section 1101, with any public entity, as defined in Public Contract Code Section 1100, including the Regents of the University of California or the Trustees of the

California State University. The term "bidder" is understood to include any partner, member, officer, director, responsible managing officer, or responsible managing employee thereof, as referred to in Section 10285.1.

Note: The bidder must place a checkmark after "has" or "has not" in one of the blank spaces provided. The above Statement is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Statement. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution.

PUBLIC CONTRACT CODE SECTION 10162 QUESTIONNAIRE

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

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

Yes No

If the answer is yes, explain the circumstances in the following space.

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PUBLIC CONTRACT CODE 10232 STATEMENT

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

National Labor Relations Board.

Note: The above Statement and Questionnaire are part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Statement and Questionnaire.

Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution.

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Noncollusion Affidavit (Title 23 United States Code

Section 112 and Public Contract Code Section 7106)

To the CONTRA COSTA TRANSPORTATION AUTHORITY.

In conformance with Title 23 United States Code Section 112 and Public Contract Code 7106 the bidder declares that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid 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 thereof to effectuate a collusive or sham bid.

Note: The above Non-collusion Affidavit is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Non-collusion Affidavit.

Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution.

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DEBARMENT AND SUSPENSION CERTIFICATION

TITLE 2, 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.

Notes: Providing false information may result in criminal prosecution or administrative sanctions.

The above certification is part of the Proposal. Signing this Proposal on the signature portion thereof also constitutes signature of this Certification.

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BIDDERS CERTIFICATE OF COMPLIANCE REGARDING WORKERS COMPENSATION

INSURANCE

In conformance with current statutory requirements of section 1860 et. seq., of the Labor Code of the State of California, the undersigned certifies that:

“As the bidder, 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.”

Bidder Name:

Signature:

Name and Title:

Date:

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DECLARATION RE NON-DISCIPLINARY OR INVESTIGATORY ACTION

The bidder declares under penalty of perjury under the laws of the State of California as follows:

The bidder has not been put on notice of and are not on any federal, state or local list of suspended or ineligible contractors: and

That the Equal Employment Opportunity Commission, State of California Department of Fair Employment and Housing, the United States Department of Labor Office of Contractor Compliance or the State of California Department of Labor has not taken disciplinary or investigatory action against the bidder, or that if such action has been taken, attached is a detailed explanation of the reason for such action, the party instituting such action and the status or outcome of such action.

(BIDDER: Check appropriate box.)

No such action has been taken against you

An explanation is provided below.

I declare under penalty of perjury under the laws of the State of California that the foregoing declaration is true and correct and that this declaration was executed in California on the date provided below.

If the answer is yes, explain the circumstances in the space below.

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CERTIFICATE OF COMPLIANCE WITH INSURANCE REQUIREMENTS

This form must be completed in its entirety and submitted along with contractor’s response to the Bid.

INSURANCE REQUIREMENTS

Contractor/Consultant has provided a copy of the insurance requirements contained in the Contra Costa Transportation Authority (“CCTA”) contract to their agent or broker to confirm the ability to meet requirements.

AND

Contractor certifies that the company or individual is fully prepared to secure the necessary insurance coverage and limits as detailed in the CCTA contract and comply with all insurance requirements.

VENDOR/FIRM INFORMATION:

Company/Individual Name

Print Name of Authorized Official

Signature of Authorized Official Date Signed

Address:

City:

State: Zip Code:

Phone No. Email Address

BROKER INFORMATION:

Name:

Address:

Phone Number:

Email Address:

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STATEMENT OF ABILITY TO OBTAIN BONDING

You declare that if awarded the contract, you will obtain the required performance and payment bonds from the following surety (sureties):

(BIDDER: Enter the name of each surety from whom you could obtain the required bonds and for each surety, place an “X” or check mark in the appropriate column. You may list more than one surety for each type bond.)

Surety Name, Address and Phone Number Performance Bond Payment Bond

You consent to the Authority contacting any of the above listed sureties to confirm their willingness to issue the bond(s) indicated.

Continued on _________ additional page(s). (BIDDER: Enter number of additional pages or “none”. If left blank, “none” will be assumed.)

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CONTRACTOR QUESTIONNAIRE

CONTRACTOR NAME:

1. BUSINESS ORGANIZATION

1.1 How many years have you been in business?

1.2 How many years have you been in business under your current name?

1.2.1 Under what other names have you conducted business?

1.3 Name(s) and title(s) of person(s) authorized to execute this contract on behalf of your business.

Attach appropriate documentation demonstrating signature authority (e.g. Corporate Resolution, Board Minutes, Operating Agreement, Articles of Organization, etc.).

1.4 If your business is a corporation, answer the following:

1.4.1 Date of incorporation:

1.4.2 State of incorporation:

1.4.3 California Secretary of State Entity ID Number:

1.4.4 Names and titles of corporate officers:

1.5 If your business is a limited liability company, answer the following:

1.5.1 Date of formation:

1.5.2 State of formation:

1.5.3 California Secretary of State Entity ID Number:

1.5.4 Is LLC managed by managers or members?

1.5.5 Manager(s)/Member(s) name(s):

1.6 If your business is a partnership or joint venture, answer the following:

1.6.1 Date of organization:

1.6.2 Type of partnership:

1.6.3 California Secretary of State Entity ID Number:

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

1.7 If your business is individually owned, answer the following:

1.7.1 Date of organization:

1.7.2 Name of owner:

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

1.9 Number of owned autos:

1.10 Number of employees:

2. LICENSING

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

2.2 List any other certifications held by your business, and the name under which they are held.

3. EXPERIENCE

3.1 List the categories of work that your business normally performs with its own forces.

3.2 List all contracts your business has completed in the past five years, giving the name of project, owner, owner's phone number, account manager, contract amount, date of completion and percentage of the cost of the work performed with your own forces. (Attach additional pages if necessary.)

3.3 State average annual value of services performed during the past five years:

Year $ Year $

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3.4 List the contracts and/or projects your business has in progress, giving the name of the project, owner/contact, contract amount and scheduled completion. (Attach additional pages if necessary.)

3.5 Has your business, under its current name or any previous names, ever failed to complete any work/contract awarded to it? If Yes, please explain. (Attach additional pages if necessary.)

4. CLAIMS AND LAWSUITS

4.1 Are there any judgments, claims, arbitration proceedings or suits pending or outstanding against your business or any its officers? If Yes, please describe. (Attach additional pages if necessary.)

4.2 Has your business filed any law suits or requested arbitration with regard to any of its contracts within the last five (5) years? If Yes, please explain. (Attach additional pages if necessary.)

4.3 During the past five years, have any complaints or claims been filed with the Department of Fair Employment and Housing (DFEH) and/or the Department of Industrial Relations (DIR) against your business? If Yes, please describe. (Attach additional pages if necessary.)

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PUBLIC WORKS CONTRACTOR REGISTRATION CERTIFICATION

Pursuant to Labor Code sections 1725.5 and 1771.1, all contractors and subcontractors that wish to bid on, be listed in a bid proposal, or enter into a contract to perform public work must be registered with the Department of Industrial Relations. See http://www.dir.ca.gov/Public-Works/PublicWorks.html for additional information.

No bid will be accepted nor any contract entered into without proof of the contractor’s and subcontractors’ current registration with the Department of Industrial Relations to perform public work.

Bidder hereby certifies that it is aware of the registration requirements set forth in Labor Code sections 1725.5 and 1771.1 and is currently registered as a contractor with the Department of Industrial Relations.*

I declare under penalty of perjury under the laws of the State of California that the foregoing declaration is true and correct and that this declaration was executed in California on the date provided below.

Name and Title:

Date:

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IRAN CONTRACTING ACT OF 2010 CERTIFICATION FORM

In accordance with Public Contract Code Section 2203, a person (as defined in Public Contract Code Section 2202(e)) is ineligible to, and shall not, bid on, submit a proposal for, for enter into or renew, a contract with a public entity for goods or services of one million dollars ($1,000,000) or more if, at the time of bid that person:

a. is identified on a list created pursuant to subsection (b) as a person engaging in investment activities in Iran as described in subsection (a) of Section 2202.5; or

b. engages in investment activities in Iran as described in subdivision (b) of Section 2202.5.

BY SUBMITTING THIS PROPOSAL OR BID AND SIGNING BELOW, THE

PROPOSER/BIDDER IDENTIFIED BELOW CERTIFIES AS FOLLOWS (REQUIRED:

SELECT ONE OF THE FOLLOWING):

□ In accordance with Public Contract Code Section 2204(a), the bidder, at the time the bid is submitted, is not identified on a list created pursuant to subdivision (b) of Public Contract Code Section 2203 as a person (as defined in Public Contract Code Section 2202(e)) engaging in investment activities in Iran described in subdivision (a) of Public Contract Code Section 2202.5, or as a person that engages in investment activities in Iran as described in subdivision (b) of Public Contract Code Section 2202.5.

□ In accordance with Public Contract Code Section 2204(b), bidder is authorized to submit this bid pursuant to Section 2203(c) and further certifies all of the following to be true: (1) the investment activities in Iran were made before July 1, 2010; (2) the investment activities in Iran have not been expanded or renewed after July 1, 2010; and (3) bidder has adopted, publicized, and is implementing a formal plan to cease the investment activities in Iran and to refrain from engaging in any new investments in Iran;

Bidder acknowledges and understands that making a false certification may subject it to civil penalties, termination of existing contract, and ineligibility to bid on a contract for a period of three (3) years in accordance with Public Contract Code Section 2205.

BIDDER INFORMATION:

Company Name

Address

City State Zip Code

Authorized Representative: Signature Date

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BUY AMERICA CERTIFICATE

The undersigned certifies on behalf of the bidder that all project materials used in the construction of the Project for which this bid is submitted will be in full compliance with the Build America, Buy America (BABA) requirements as mandated in the Infrastructure Investment and Jobs Act (IIJA) Pub. L. No. 117-58 and 2 CFR 184.

The bidder further certifies that it will maintain all records and documents pertinent to the Buy America requirement, for not less than three years from the date of Final Acceptance (Project). These files will be available for inspection and verification by the Department and/or the Federal Highway Administration.

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NONLOBBYING CERTIFICATION

FOR FEDERAL-AID CONTRACTS

The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that:

(l) 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.

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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:

a. contract a. bid/offer/application a. initial

b. grant

c. cooperative agreement

d. loan

b. initial award

c. post-award

b. material change

For Material Change Only:

e. loan guarantee

f. loan insurance year quarter 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 Subawardee Tier , if known

Congressional District, if known Congressional District, if known

6. Federal Department/Agency: 7. Federal Program Name/Description:

CFDA Number, if applicable

8. Federal Action Number, if known: 9. Award Amount, if known:

10. a. Name and Address of Lobby Entity 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 (check all that apply) 13. Type of Payment (check all that apply)

$ actual planned a. retainer

b. one-time fee

12. Form of Payment (check all that apply): c. commission

a. cash d. contingent fee

b. in-kind; specify: nature e deferred value f. other, specify

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 necessary)

15. Continuation Sheet(s) attached: Yes No

16. Information requested through this form is authorized by Title 31 U.S.C. Section 1352. This disclosure of lobbying Signature:

reliance was placed by the tier above when his transaction was made or entered into. This disclosure is required Print Name:

pursuant to 31 U.S.C. 1352. This information will be reported to Congress semiannually and will be available for public inspection. Any person who fails to file the required Title:

disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Telephone No.: Date:

Authorized for Local Reproduction Federal Use Only: Standard Form - LLL orm ati on ids Thro ug h B id Exp

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, subgrants and contract awards under grants.

5. If the organization filing the report in Item 4 checks "Subawardee" then enter the full name, address, city, state and zip code of the prime 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. For example, Department of Transportation, United States Coast Guard.

7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loan commitments.

8. Enter the most appropriate Federal identifying number available for the Federal action identification in item 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 influenced the covered Federal action.

(b) Enter the full names of the individual(s) performing services and include full address if different from 10 (a). Enter Last Name, First Name and Middle Initial (Ml).

11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to the lobbying entity (item 10). Indicate whether the payment has been made (actual) or will be made (planned). Check all boxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be made.

12. Check the appropriate box. Check all boxes that apply. If payment is made through an in-kind contribution, specify the nature and value of the in-kind payment.

13. Check the appropriate box. Check all boxes that apply. 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…