D._Price_Quote_Proposal_Sheets_f.pdf

STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION

PRICE QUOTE PROPOSAL FOR UNIT ITEMS

DOT ADM-1509 (REV 02/2025)

Americans with Disabilities Act (ADA) Notice: This document is available in alternative accessible formats. For more information, please contact the Forms Management Unit at (279) 234-2284, TTY 711, in writing at Forms Management Unit, 1120 N Street, MS-89, Sacramento, CA 95814, or by email at Forms.Management.Unit@dot.ca.gov.

PERSONAL INFORMATION NOTICE

Pursuant to the Federal Privacy Act (5 U.S.C, Section 552 et seq.) and the Information Practices Act of 1977 (IPA) (Civil Code Sections 1798 et seq.) declares that the right to privacy is a personal and fundamental right protected by the California and United States Constitutions. Please be advised that this form requests personal information. The term “personal information” means any information that is maintained by an agency that identifies or describes an individual, including, but not limited to, the individual’s name, social security number, physical description, home address, home telephone number, education, financial matters, and medical or employment history. It includes statements made by, or attributed to, the individual. (Civil Code, § 1798.3, subdivision (a).)

Information Collection and Access: California law requires the following information to be provided when collecting information from individuals.

(See, for example, Civil Code, § 1798.17.)

Agency Name and Division Within the Agency Requesting the Information:

California Department of Transportation, Division of Procurement and Contracts, Office 2

Title of Official Responsible for Information Maintenance:

Support Staff, Protest and Policy at the Division of Procurement and Contracts at (279) 234-2382, or in writing at Office 2, 1727 30th Street, MS 65, Sacramento, CA 95816, or by email at NonIT.Contracts@dot.ca.gov

Maintenance of the Information Authorized By:

California Constitution, Article 1, Section 1 Government Code Section 11015.5 Health Insurance Portability and Accountability Act (HIPAA) of 1996 – Privacy Rule Information Practices Act (Civil Code Section 1798 et seq.)

Public Records Act (Government Code Section 6250 et seq.) State Administrative Manual (SAM) Section Privacy - 5310 et seq.

Statewide Information Management Manual (SIMM) 5310-A and 5310-B National Institute of Standards and Technology (NIST) Special Publication 800-53

Consequences of Not Providing All or Any Part of the Requested Information:

Disclosure of this information is mandatory. Failure to provide information will prevent eligibility in the program and delay or prevent the processing of this form.

Principal Purpose(s) for Which the Information Will Be Used:

The request for personal information is to facilitate processing this form and review eligibility for the program.

Known Disclosures:

The information shall be disclosed to authorized California Department of Transportation employees and the information will remain confidential.

Right of Access to Records:

Individuals have the right to access information provided and may request a correction or deletion of records. Exceptions may include, but are not limited to, investigations and public transparency laws. Personal Information will only be disclosed as permitted by the Information Practices Act, Civil Code, §§ 1798–1798.83, or as otherwise required by law. To request access to, or to request correction or deletion of, information provided in this form you may contact the Official Responsible for Information Maintenance identified above.

DOT ADM-1509 (REV 02/2025)

Americans with Disabilities Act (ADA) Notice: This document is available in alternative accessible formats. For more information, please contact the Forms Management Unit at (279) 234-2284, TTY 711, in writing at Forms Management Unit, 1120 N Street, MS-89, Sacramento, CA 95814, or by email at Forms.Management.Unit@dot.ca.gov.

Contract Number 01A6677

PROPOSAL TO THE STATE OF CALIFORNIA

DEPARTMENT OF TRANSPORTATION

APPROXIMATE MAGNITUDE OF WORK

$220,000.00

FOR: Men-20-20.0 Construct communication system (EA 01-0P2504)

The undersigned, as bidder, declares that the only persons or parties interested in this proposal as principals are those named herein; that this proposal is made without collusion with any other person, firm or corporation; and the bidder has carefully examined the proposed form of contract and the plans therein referred, and proposes and agrees, if this proposal is accepted, that the bidder will contract with the State of California to provide all necessary labor, materials, tools, or equipment to do all of the work specified in the contract, in the time and manner therein prescribed, and that the bidder shall take in full payment therefore the following price:

Item Number

Cost Code

Item Unit of

Measure Estimated Quantity

Unit Price (In Figures)

Item Total (In Figures)

1 070030 1LSLEAD COMPLIANCE PLAN

2 130100 1LSJOB SITE MANAGEMENT

3 130201 1LS

WATER POLLUTION CONTROL

PROGRAM

4 130540 55SQYDTEMPORARY TACKED STRAW

5 130640 110LFTEMPORARY FIBER ROLL

6 130900 1LSTEMPORARY CONCRETE WASHOUT

7 170103 1LSCLEARING AND GRUBBING (LS)

8 190101 10CYROADWAY EXCAVATION

9 205035 2.3CYWOOD MULCH

10 260203 11CYCLASS 2 AGGREGATE BASE (CY)

11 800360 70LFCHAIN LINK FENCE (TYPE CL-6)

DOT ADM-1509 (REV 02/2025)

Contract Number 01A6677

Item Number

Cost Code

Item Unit of

Measure Estimated Quantity

Unit Price (In Figures)

Item Total (In Figures)

Americans with Disabilities Act (ADA) Notice: This document is available in alternative accessible formats. For more information, please contact the Forms Management Unit at (279) 234-2284, TTY 711, in writing at Forms Management Unit, 1120 N Street, MS-89, Sacramento, CA 95814, or by email at Forms.Management.Unit@dot.ca.gov.

12 802510 2EA5' CHAIN LINK GATE (TYPE CL-6)

13 034264 1LSCOMMUNICATION SYSTEM

TOTAL

1. If the bidder is awarded the contract and refuses to execute the contract forms presented for signature within the time and manner required, the bidder will be liable to the Department of Transportation for actual damages resulting to Caltrans therefrom or 10% of the amount bid, whichever is less. Should the bidder fail to pay these damages, Caltrans may list the bidder as in default and ineligible to bid future Caltrans projects.

2. The bid of any Contractor who is currently in default with Caltrans on a contract already awarded may be regarded as non-responsive and may be rejected. Default is defined as being within a period of liquidated damages on uncompleted work or under notice to begin or complete a contract where work has not commenced within the time limit set forth in that notice or was suspended without valid cause, or failure to perform the required work in a manner satisfactory to the Engineer.

I agree that by providing my electronic signature for this form, I agree to conduct business transactions by electronic means and that my electronic signature is the legal binding equivalent to my handwritten signature. I hereby agree that my electronic signature represents my execution or authentication of this form, and my intent to be bound by it.

BUSINESS NAME (PRINT OR TYPE) DATE

PRINT NAME OF AUTHORIZED PERSON

BY (MUST BE SIGNED BY AUTHORIZED PERSON) TITLE BUSINESS PHONE

BUSINESS ADDRESS (STREET / P.O. BOX, CITY, STATE) ZIP EMAIL

SMALL BUSINESS

CERTIFICATION NUMBER

STATE CONTRACTOR'S

LICENSE BOARD LICENSE

NUMBER

STATE CONTRACTOR'S

LICENSE BOARD LICENSE

CLASSIFICATION

FED ID NUMBER /

SOCIAL SECURITY NUMBER

DEPARTMENT OF INDUSTRIAL RELATIONS REGISTRATION NUMBER