Cat Canyon Creek Bridge No. 51P-500 Storm Damage Repairs.pdf

COUNTY OF SANTA BARBARA

DEPARTMENT OF PUBLIC WORKS

TRANSPORTATION DIVISION

BID BOOK

FOR

CAT CANYON CREEK BRIDGE NO. 51P-500

STORM DAMAGE REPAIRS

COUNTY PROJECT NO. 25STM3-4N03

IN THE 4TH SUPERVISORIAL DISTRICT

UNDER:

Bid Book dated 09/24/2026 Standard Specifications dated 2025

Project Plans approved 09/23/2026 Standard Plans dated 2025

BID OPENING LOCATION:

PlanetBids https://www.planetbids.com/portal/portal.cfm?CompanyID=43874

BID OPENING TIME AND DATE:

2:00 PM on Thursday, October 15, 2026

Electronic Advertising Contract

CHRISTOPHER SNEDDON

DIRECTOR OF PUBLIC WORKS

https://www.planetbids.com/portal/portal.cfm?CompanyID=43874

County Project No. 25STM3-4N03 24 September 2026 BID – Page 2 of 17

AGREEMENT TO ACCEPT ELECTRONIC SIGNATURE

Pursuant to California Civil Code Section 1633.5(b), the parties hereby agree, unless otherwise prohibited by law, that where project documents (including Bid submittals, Contract(s), and related Agreement(s)) require a party signature, an electronic signature, as that term is defined at California Civil Code Section 1633.2(h), shall have the full force and effect of an original (“wet”) signature.

A responsible officer of each party has read and understands the contents of this Agreement and is empowered and duly authorized on behalf of that party to execute it.

County of Santa Barbara Bidder or Contractor

Department of Public Works Firm Name:

By: By:

Alma D. Garcia Name:

Project Manager Title:

September 24, 2026 Date:

County Project No. 25STM3-4N03 24 September 2026 BID – Page 3 of 17

PROPOSAL

TO THE HONORABLE BOARD OF SUPERVISORS

OF THE COUNTY OF SANTA BARBARA, STATE OF CALIFORNIA

COUNTY PROJECT NO. 25STM3-4N03

NAME OF BIDDER

BUSINESS P.O. BOX

CITY, STATE, ZIP

BUSINESS STREET ADDRESS

(Include even if P.O. Box is used)

CITY, STATE, ZIP

TELEPHONE NO. FAX NO.

CONTRACTOR LICENSE NO. LICENSE CLASSIFICATION

PUBLIC WORKS CONTRACTOR REGISTRATION NO.

BUSINESS TYPE (Check one) Corporation: Partnership: Sole Proprietorship:

CONTACT PERSON NAME

CONTACT PERSON PHONE NO.

CONTACT PERSON EMAIL

EMPLOYER’S TAX IDENTIFICATION NUMBER

1. Bidder agrees, if this bid is accepted, to enter into a contract with Santa Barbara County, to perform the work provided in the Contract under the terms of the Contract for the price or prices bid.

For a lump sum or unit price-based bid, Bidder additionally agrees to perform the work within the number of working days shown on the Notice to Bidders.

For a cost plus time-based bid on a contract without a plant establishment period, Bidder additionally agrees to perform the work within the number of working days.

For a cost plus time-based bid on a contract with a plant establishment period, Bidder additionally agrees to perform the non-plant establishment work within the number of working days for non-plant establishment work.

2. For a lump sum based bid, Bidder submits this bid with a total price in the total bid space provided on PlanetBids.

For a unit price or cost plus time-based bid, Bidder submits this bid with a unit price and the item total (the product of the unit price and the quantity) for each item and a total price (the sum of the item totals) in the spaces provided on PlanetBids.

For a cost plus time-based bid, Bidder submits this bid with working days bid for non-plant establishment work, total bid for time, and total bid for bid comparison in the spaces provided on PlanetBids.

Bidder agrees:

2.5. Unit prices and item totals are interpreted by the number of digits and decimal placement. Do not round item totals or the total bid.

County Project No. 25STM3-4N03 24 September 2026 BID – Page 4 of 17

2.6. Bid comparisons are prescribed in Section 2-1.09 of the Standard Specifications as amended by the County’s General Provisions.

2.7. The County’s decision on the bid amount is final.

3. Bidder has and acknowledges all addenda (if applicable) as required on PlanetBids

4. Bidder submits this bid with one of the following forms of bidder security equal to at least 10 percent of the bid:

Bidder Security Amount: $ ___________________________________________________________________

Payment Form (Check one): Cash _____ Cashier’s Check _____ Certified Check _____ Bidder’s Bond _____

5. Bidder’s signature is an affirmation of the included certifications. Bidder is cautioned that making a false certification may result in one or more of the following:

5.1. Criminal prosecution.

5.2. Rejection of Bid.

5.3. Rescission of the award.

5.4. Termination of the Contract.

BY (Authorized signature) DATE SIGNED (Do not type)

PRINTED NAME AND TITLE OF PERSON SIGNING

County Project No. 25STM3-4N03 24 September 2026 BID – Page 5 of 17

EXHIBIT 12-B - BIDDERS LIST

In accordance with 49 CFR 26.11 the bidder shall list itself and all subcontractors, truckers, or suppliers who provided a quote or bid on the project regardless of whether the firm was selected by the bidder to participate. Photocopy this form for additional firms

Local Agency: Federal Project Number: Bid Opening Date:

Prime Contractor Information

Firm Name Applicable NAICS and/or Work Category

Code(s)

Annual Gross Receipts

< $1 million $1- $3 million $3 - $6 million $6 - $10 million

> $10 million

Prefer not to state

Address

City State ZIP

Date Firm Established:

Subcontractor Information

Firm Name Applicable NAICS and/or Work Category

Code(s)

Annual Gross Receipts

< $1 million $1- $3 million $3 - $6 million $6 - $10 million

City State ZIP Firm Being Used?

YES

NO

Subcontractor Information

Firm Name Applicable NAICS and/or Work Category

Code(s)

Annual Gross Receipts

< $1 million $1- $3 million $3 - $6 million $6 - $10 million

NO

Subcontractor Information

Firm Name Applicable NAICS and/or Work Category

Code(s)

Annual Gross Receipts

< $1 million $1- $3 million $3 - $6 million $6 - $10 million

NO

Subcontractor Information

Firm Name Applicable NAICS and/or Work Category

Code(s)

Annual Gross Receipts

< $1 million $1- $3 million $3 - $6 million $6 - $10 million

NO

County Project No. 25STM3-4N03 24 September 2026 BID – Page 6 of 17

Subcontractor Information

Firm Name

Applicable NAICS and/or Work

Category Code(s)

Annual Gross Receipts

< $1 million

$1- $3 million

$3 - $6 million

$6 - $10 million

NO

Subcontractor Information

Firm Name

Applicable NAICS and/or Work

Category Code(s)

Annual Gross Receipts

< $1 million

$1- $3 million

$3 - $6 million

$6 - $10 million

NO

Subcontractor Information

Firm Name

Applicable NAICS and/or Work

Category Code(s)

Annual Gross Receipts

< $1 million

$1- $3 million

$3 - $6 million

$6 - $10 million

NO

Subcontractor Information

Firm Name

Applicable NAICS and/or Work

Category Code(s)

Annual Gross Receipts

< $1 million

$1- $3 million

$3 - $6 million

$6 - $10 million

NO

Note: None of the information requested on this form is material to the determination of which bidder’s Bid is the lowest responsive bid.

Signed: Title:

Printed Name: Company Name:

County Project No. 25STM3-4N03 24 September 2026 BID – Page 7 of 17

SUBCONTRACTOR LIST

COUNTY PROJECT NO. 25STM3-4N03

The Bidder must identify each subcontractor performing work in an amount in excess of 1/2 of 1 percent of the total bid or $10,000, whichever is greater (Public Contract Code 4100 § et seq.). Submit the name and location of the place of business, telephone and fax number, and license number and classification of each subcontractor.

List the portion of work that will be done by each subcontractor for each subcontract by individual item number, percent of item, dollar amount of item, and brief description.

NAME OF BIDDER: SUBCONTRACTOR LIST, PAGE NO. OF

Name Item No. Percent of Item Dollar Amount

Address Description of Above Item

City, State, Zip

Phone Number Item No. Percent of Item Dollar Amount

Fax Number Description of Above Item

E-Mail Address

Public Works Contractor Registration Number Item No. Percent of Item Dollar Amount

DIR Registration Number

License Number and Classification Description of Above Item

City, State, Zip

Phone Number Item No. Percent of Item Dollar Amount

Fax Number Description of Above Item

E-Mail Address

Public Works Contractor Registration Number Item No. Percent of Item Dollar Amount

Total Dollar Amount of This Page Total Dollar Amount of All Pages

BY:

Bidder’s Signature

NOTE: This form may be reproduced and attached behind this page to list more Subcontractors.

County Project No. 25STM3-4N03 24 September 2026 BID – Page 8 of 17

SUBCONTRACTOR LIST

COUNTY PROJECT NO. 25STM3-4N03

The Bidder must identify each subcontractor performing work in an amount in excess of 1/2 of 1 percent of the total bid or $10,000, whichever is greater (Public Contract Code 4100 § et seq.). Submit the name and location of the place of business, telephone and fax number, and license number and classification of each subcontractor.

List the portion of work that will be done by each subcontractor for each subcontract by individual item number, percent of item, dollar amount of item, and brief description.

NAME OF BIDDER: SUBCONTRACTOR LIST, PAGE NO. OF

City, State, Zip

Phone Number Item No. Percent of Item Dollar Amount

Fax Number Description of Above Item

E-Mail Address

Public Works Contractor Registration Number Item No. Percent of Item Dollar Amount

City, State, Zip

Phone Number Item No. Percent of Item Dollar Amount

Fax Number Description of Above Item

E-Mail Address

Public Works Contractor Registration Number Item No. Percent of Item Dollar Amount

Total Dollar Amount of This Page Total Dollar Amount of All Pages

BY:

Bidder’s Signature

NOTE: This form may be reproduced and attached behind this page to list more Subcontractors.

County Project No. 25STM3-4N03 24 September 2026 BID – Page 9 of 17

BIDDER’S BOND

KNOW ALL MEN BY THESE PRESENTS:

That we, as Principal, and as Surety

(hereinafter referred to as Surety), are held firmly bound unto the County of Santa Barbara, State of California (hereinafter called Owner) in the penal sum of 10 percent of the total aggregate amount of the bid of the Principal above named, submitted by said Principal to Owner for the work described below, for the payment of which sum in lawful money of the United States, well and truly to be made, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally, firmly by these presents. Surety shall be and hereby warrants that it is listed in the Insurance Organizations Authorized By The Insurance Commissioner To Transact Business of Insurance In The State Of California During 1995 (including changes effective January 1, 1996), published by the Department of Insurance, State of California or successor publications. In no case shall the liability of the Surety hereunder exceed the sum of

DOLLARS, ($ ).

The condition of this obligation is such that a bid to Owner for certain construction specifically described as follows:

CAT CANYON CREEK BRIDGE NO. 51P-500

STORM DAMAGE REPAIRS

IN THE 4TH SUPERVISORIAL DISTRICT

for which bids are to be opened on Thursday, October 15, 2026, has been submitted by Principal to Owner.

NOW, THEREFORE, if the aforesaid Principal shall not withdraw said bid within the period therein specified after the opening of the same, or, if no period be specified within sixty (60) days after said opening and shall within the period specified therefor, or, if no period be specified, within eight (8) days after the prescribed forms are presented to him or her for signature, enter into a written Contract with Owner, in the prescribed form, in accordance with the bid as accepted, and file the two Bonds with Owner, one to guarantee faithful performance and the other to guarantee payment for labor and materials, as required by law, then this obligation shall be null and void, otherwise, it shall remain in full force, virtue and affect.

Said Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of said Contract or to the work to be performed thereunder or the Specifications accompanying the same shall in any manner affect its obligations on this bond, and it does hereby waive notice of any change, extension, alteration, or addition.

It is hereby agreed that any progress payment made after the scheduled completion date will not constitute a waiver of any liquidated damages heretofore agreed upon.

In the event suit is brought upon said Bond by Owner and judgment is recovered, the Surety shall pay all costs incurred by Owner in such suit, including a reasonable attorney’s fee to be fixed by the Court.

Death, Bankruptcy, Receivership, Going Out of Business for any reason, or incompetency of the Principal shall not relieve the Surety of its obligations hereunder.

County Project No. 25STM3-4N03 24 September 2026 BID – Page 10 of 17

Name of Principal

Date Signature of Principal

(Seal)

Name of Surety

City, State, Zip

(Seal)

Date Signature of Surety's Attorney-in-fact

Surety's Agent for Service of Process (located within the State of California)

Name of Agent

City, State, Zip

Telephone Number

Fax Number

NOTE: Signatures of those executing for Surety MUST be properly acknowledged.

This form may be reproduced for transmittal to the Surety for execution and attached to the front of this, the original Bid Bond Form.

County Project No. 25STM3-4N03 24 September 2026 BID – Page 11 of 17

PRICE INDEX FLUCTUATIONS OPT OUT FORM

STATE OF CALIFORNIA DEPARTMENT OF TRANSPORTATION

DIVISION OF ENGINEERING SERVICES – OFFICE ENGINEER

DES-OE0102.12A (REV. 8/2012)

You may opt out of the payment adjustments for price index fluctuations specified in section 9-1.07 of the Specifications. To opt out, complete this form and submit it with your bid.

Bidder’s Name County Project No. 25STM3-4N03

☐ I opt out of the payment adjustments for price index fluctuations.

Date Signature

County Project No. 25STM3-4N03 24 September 2026 BID – Page 12 of 17

CERTIFICATIONS: PUBLIC CONTRACT CODE

UNDOCUMENTED ALIENS EMPLOYMENT

Under Public Contract Code § 6101, the Bidder certifies compliance with state and federal law respecting the employment of undocumented aliens.

NONCOLLUSION AFFIDAVIT

To the COUNTY of SANTA BARBARA

DEPARTMENT OF PUBLIC WORKS

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.

CHILD SUPPORT COMPLIANCE ACT

Under Public Contract Code § 7110, the contractor acknowledges that:

1. The contractor recognizes the importance of child and family support obligations and shall fully comply with all applicable state and federal laws relating to child and family support enforcement, including, but not limited to, disclosure of information and compliance with earnings assignment orders, as provided in Chapter 8 (commencing with section 5200) of Part 5 of Division 9 of the Family Code; and

2. The contractor to the best of its knowledge is fully complying with the earnings assignment orders of all employees and is providing the names of all new employees to the New Hire Registry maintained by the Employment Development Department.

County Project No. 25STM3-4N03 24 September 2026 BID – Page 13 of 17

VIOLATION OF LAW OR A SAFETY REGULATION

Under Public Contract Code § 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.

ANTITRUST LAW

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.

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.

County Project No. 25STM3-4N03 24 September 2026 BID – Page 14 of 17

EXECUTIVE ORDER N-6-22 (EO) REGARDING SANCTIONS IN RESPONSE TO RUSSIAN AGGRESSION

IN UKRAINE.

Notice to all Santa Barbara County Contractors, Suppliers and Grantees:

On March 4, 2022, Governor Gavin Newsom issued Executive Order N-6-22 (EO) regarding sanctions in response to Russian aggression in Ukraine. The EO is located at https://www.gov.ca.gov/wp-content/uploads/2022/03/3.4.22-Russia-Ukraine-Executive-Order.pdf

This serves as a notice under the EO that as a vendor, contractor or grantee, compliance with the economic sanctions imposed in response to Russia's actions in Ukraine is required, including with respect to, but not limited to, the federal executive orders identified in the EO and the sanctions identified on the U.S. Department of the Treasury website ( https://home.treasury.gov/policy-issues/financial-sanctions/sanctions-programs-and-country-information/ukraine-russia-related-sanctions). Failure to comply may result in the termination of contracts or grants, as applicable.

Note: The above Notice is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute acknowledgement and compliance with this requirement.

ANTIBIDDER RESPONSIBILITY QUESTIONNAIRE

Failure to truthfully answer the following questions will result in a finding that the bid is nonresponsive. The Bidder must complete, under penalty of perjury, the following questionnaire:

1. Within the past 10 years, has the Bidder been found to be a nonresponsible bidder by any public entity, including federal, State, local, or regional entities?

☐ Yes ☐ No

2. Within the past 10 years, have any of the Bidder's officers or employees with a proprietary interest in the Bidder been determined to be a nonresponsible bidder by a public entity, including federal, State, local or regional entities?

☐ Yes ☐ No

3. Is there any officer or employee of the Bidder who now has or has had any proprietary interest in another company that bid or bids on public works projects whose company has been determined to be a nonresponsible bidder by any public entity, including federal, State, local, or regional entities?

☐ Yes ☐ No

4. If the answer to any of the 3 preceding questions is yes, disclose all pertinent details of the determination of nonresponsibility, including:

4.1. Date of each nonresponsibility determination

4.2. Name of each public agency issuing the nonresponsibility determination and a contact person at that agency who would have information about the determination

4.3. Contract number for each nonresponsibility determination https://www.gov.ca.gov/wp-content/uploads/2022/03/3.4.22-Russia-Ukraine-Executive-Order.pdf https://home.treasury.gov/policy-issues/financial-sanctions/sanctions-programs-and-country-information/ukraine-russia-related-sanctions https://home.treasury.gov/policy-issues/financial-sanctions/sanctions-programs-and-country-information/ukraine-russia-related-sanctions https://home.treasury.gov/policy-issues/financial-sanctions/sanctions-programs-and-country-information/ukraine-russia-related-sanctions

County Project No. 25STM3-4N03 24 September 2026 BID – Page 15 of 17

CERTIFICATIONS: CODE OF FEDERAL REGULATIONS

EQUAL EMPLOYMENT OPPORTUNITY REGULATIONS CERTIFICATION

CFR, Title 41, Chapter 60

The bidder_______________________________, proposed subcontractor

______________________________, hereby certifies that he ☐ has, ☐ has not, participated in a previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders 10925, 11114, or 11246, and that, where required, he 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

DEBARMENT AND SUSPENSION CERTIFICATION

TITLE 49, CODE OF FEDERAL REGULATIONS, PART 29

The bidder, under penalty of perjury, certifies that, except as noted below, he/she or any other person associated therewith in the capacity of owner, partner, director, officer, manager:

is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by any Federal agency;

has not been suspended, debarred, voluntarily excluded or determined ineligible by any Federal agency within the past 3 years;

does not have a proposed debarment pending; and has not been indicted, convicted, or had a civil judgment rendered against it by a court of competent jurisdiction in any matter involving fraud or official misconduct within the past 3 years.

If there are any exceptions to this certification, insert the exceptions in the following space.

Exceptions will not necessarily result in denial of award, but will be considered in determining bidder responsibility. For any exception noted above, indicate below to whom it applies, initiating agency, and dates of action.

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 shall also constitute signature of this Certification.

County Project No. 25STM3-4N03 24 September 2026 BID – Page 16 of 17

CERTIFICATIONS: UNITED STATES CODE

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.

County Project No. 25STM3-4N03 24 September 2026 BID – Page 17 of 17

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. contract

a. bid/offer/application

a. bid/offer/application

a. initial

a. initial b. grant b. initial award b. material change

c. cooperative agreement c. post-award

d. loan For Material Change Only:

e. loan guarantee year _____ quarter _________

f. loan insurance date of last report __________

4. Name and Address of Reporting Entity 5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime:

Prime 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 reliance was placed by the tier above when his transaction was made or entered into. This disclosure is required 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 disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

Signature: ________________________________________

Print Name: ______________________________________

Title: ____________________________________________

Telephone No.: _____________________ Date: __________

Authorized for Local Reproduction

Federal Use Only: Standard Form - LLL