BID PROPOSAL

In and for the

City of Los Angeles, California Department of Public Works

Bureau of Engineering

SIDEWALK REPAIR PROGRAM

PACKAGE NO. 86 (LA 28)

W. O. E1909515

Rev. 9/13/2017 i

TABLE OF CONTENTS

PAGE

Table of Contents…………………………………..……………..………… 2 pages

Important Notice……………………………………………………………. 5 pages

PART I

Bid Proposal ………………………………………………………………… 1-1

Schedule of Work and Prices……………………………………………… 1-2a and 1-2b

Responsibility Questionnaire……………………………………………… 1-3a thru 1-3m

Bidder Certification Form 50………………………………..……………… 1-3n

Signature Sheet and Affidavit…………………………………………… 1-4

Bid Bond……………………………………………………………………… 1-5

List of Subcontractors………………………………………………………. 1-6 and 1-7

Vendor and/or Supplier and Broker Participation Recognition………… 1-8

Certification of Compliance with Child Support Obligations…………… 1-9

Equal Benefits Ordinance/First Source Hiring Ordinance …………… 1-10

Iran Contracting Act of 2010 Compliance Affidavit………………….…. 1-11a Thru 1-11c

PART II

City of Los Angeles Non-Discrimination, Equal Employment Practices, Affirmative Action Requirements for Construction Contractors………… 2-1 and 2-2

PART III

Board of Public Works Business Inclusion Program (BIP) Outreach… 3-1 thru 3-22

PART IV

General Instructions and Information for Bidders……..………….…… 4-1 thru 4-7

Senate Bill 854…………………………………………………………… 1 page

Required Insurance and Minimum Limits………………………….…… 1 page

Department of Water & Power Standard Drawing……………………… 6 pages

Holiday Season Street Closure Restrictions…………………………… 11 pages

SIDEWALK REPAIR PROGRAM PACKAGE NO. 86 (LA 28) - W.O. E1909515

Rev. 9/13/2017 ii

PART IV (Cont.)

Board of Public Works Mandatory Subcontracting Minimum………… 2 pages

Board of Public Works “Zero Sanitary Sewer Overflows” Policy…….… 3 pages

City of Los Angeles Labor Compliance Manual………………………… 13 pages

Important Notice Section…………………………………………………… 1 page

Equal Benefits Ordinance………………………………………………… 4 pages

Municipal Lobbying Ordinance……………………………………..……… 24 pages

Disclosure Ordinances Affidavit…………………………………….…… 1 page

Local Business Preference Program……………………………………… 7 pages

Construction & Demolition Waste Recycling Ordinance Compliance Packet (supersedes General Conditions, Article 00221 and General Requirements, Section 01572) …………………………………………… 12 pages

Contractors' Use of Criminal History for Consideration of Employment Applications Ordinance…………………….…………………………….. 1 page

Contractor Evaluation Program…………….. …………………….……… 1 page

Contractor Special Recognition Program.. …………………….………

1 page

Buy Clean California Act Implementation……………………………… 2 pages

Executive Directive 35 Equitable Access to Contracting Opportunities...1 page

ATTACHMENTS

1. Plan Drawings, Index No. D-35991(117 sheets)

2. Specifications

a. General Conditions

b. General Requirements

c. Technical Specifications

d. Reference Sheets

Rev. 02/22/2022 Page 1 of 5

IMPORTANT NOTICE

A. BIDDER’S SUBMITTALS

Part I - Must be properly completed and submitted to the Board of Public Works no later than the time and date designated on Page 1-1 of the Proposal at Los Angeles City Hall, 200 N. Spring Street, Room 355, Los Angeles, California 90012, Attention: Contract Section.

Changes have been made to the documentation and submittal procedures for the Equal Benefits Ordinance. Refer to the Ordinance in the Table of Contents for additional information.

Part II - Bidders are required to complete and upload the Non-Discrimination/Equal Employment Practices Certification and Affirmative Action Plan Affidavit on the City’s Regional Alliance Marketplace for Procurement (RAMP) at the time of registration on RAMP, but no later than the bid date designated on Page 1-1 of the Proposal. However, Bidders with current OCC approval for their Non- Discrimination/Equal Employment Practices Certification and Affirmative Action Plan Affidavit do not need to re-submit unless the approval is 30 days or less from expiration. In lieu of the Los Angeles City Affirmative Action Plan, the bidder may submit its own Affirmative Action Plan by uploading it onto the City’s RAMP. A bidder’s compliance with the aforementioned Non- Discrimination/Equal Employment Practices and Affirmative Action filing requirements will be a factor in determining the responsiveness of their bid/proposal.

The Non-Discrimination/Equal Employment Practices Certification and the City of Los Angeles Affirmative Action Plan Affidavit shall be effective for a period of twelve months from the date it was approved by the Office of Contract Compliance (OCC) or when it was uploaded onto the City’s RAMP.

Note that significant changes have been made to the documentation and submittal procedures for the Non-Discrimination/Equal Employment Practices and Affirmative Action Plan. Refer to the appropriate Ordinances in the Table of Contents for the instructions and forms. For questions regarding the documents and/or submission procedures, call (213) 847-2625. For technical questions regarding RAMP, use the support link located at the bottom of the web page.

Part III - Submission of the Business Inclusion Program (BIP) Outreach Documentation is mandatory. All bidders must perform their BIP Outreach Documentation on the City’s Regional Alliance Marketplace for Procurement (RAMP) as described in Part III of the Bid Proposal. All bidders must submit this documentation on the City’s RAMP. All BIP outreach documentation including the summary sheet must be submitted on the RAMP’s BIP Outreach Reports System and must be submitted by 4:30 p.m. of the following City working day from the date bids are received by the Board of Public Works.

Rev. 02/22/2022 Page 2 of 5

NOTE: THE BIDDER’S FAILURE TO PASS THE BIP OUTREACH

DOCUMENTATION PROCESS WILL RENDER THE BID NON-

RESPONSIVE.

B. PRE-BID MEETING - BUSINESS INCLUSION PROGRAM (BIP) OUTREACH

(See Part III of the Proposal)

A pre-bid meeting has been scheduled for August 4. 2026 at 10:00am via Google Meet. Join by Phone: (US) +1 478-292-3681 PIN: 209 501 734# or via Video Link:

meet.google.com/oyb-raet-ptt

The City highly recommends all bidders to attend the pre-bid meeting. The purposes of this meeting are to inform prospective bidders of the scope of work, discuss the submittal requirements, answer any related technical and non-technical questions, explain the provisions relative to the utilization of MBEs, WBEs, OBEs, Small Business Enterprises (SBE), Emerging Business Enterprises (EBE), and Disabled Veteran Business Enterprises (DVBE) and describe how to submit the BIP Outreach Documentation using the City’s RAMP and explain how to obtain a complete set of bid documents, including all addenda, for this project through the City’s RAMP.

The Board of Public Works anticipated level of MBE participation is 4%, WBE participation is 2%, SBE participation is 25%, EBE participation is 8%, and DVBE participation is 3% (See Part III of the Proposal).

C. BIDDER INFORMATION AND ASSISTANCE

Requests for clarification of conflicts and omissions from the contract documents shall be addressed in writing to:

David Nguyen Sidewalk Compliance Division 1149 S Broadway Public Works Building Los Angeles, CA 90015 E-MAIL: David.Nguyen@lacity.org

The deadline for receipt of written technical questions is August 12, 2026.

D. MANDATORY SUBCONTRACTING MINIMUM (MSM) REQUIREMENT

(See Part IV of the Proposal)

To be eligible for award of this project, the Board of Public Works requires the bidder to subcontract a minimum of 25% of the Total Bid Amount (excluding the Fixed Cost Items designated in the Schedule of Work and Prices) to any qualified, available subcontractor. FAILURE BY THE BIDDER TO SUBCONTRACT THE MINIMUM

PERCENTAGE SPECIFIED HEREIN MAY RESULT IN THE BOARD OF PUBLIC

WORKS DECLARING THE BID NON-RESPONSIVE.

E. CONTRACTOR PARTICIPATION

The Prime Contractor shall perform, with its own organization, contract work amounting

Rev. 02/22/2022 Page 3 of 5 to at least 50% of the contract price. Any items designated as specialty items by the City and performed by Subcontractors shall be deducted from the contract price before computing the amount of the work required to be performed by the Prime Contractor with its own forces. This percentage shall be based upon the original contract price, exclusive of specialty items performed by Subcontractors, but include the cost of materials and manufactured products purchased or produced by the Prime Contractor.

F. CONTRACTOR’S LICENSE CLASSIFICATION REQUIRED TO BID

At the time of bid the contractor must possess a valid State of California Contractor's License Classification of "A.”

G. CALIFORNIA STATE SENATE BILL 854:

I. Contractors are advised of the following changes made by California State

Senate Bill 854 to the State of California Department of Industrial Relations:

1. No contractor or subcontractor may be listed on a bid proposal for a public works project (submitted on or after March 1, 2015) unless registered with the California Department of Industrial Relations (DIR) pursuant to Labor Code section 1725.5 [with limited exceptions from this requirement for bid purposes only under Labor Code section 1771.1(a)].

2. No contractor or subcontractor may be awarded a contract for public work on a public works project (awarded on or after April 1, 2015) unless registered with the DIR pursuant to Labor Code section 1725.5.

3. DIR maintains a current list of registered contractors.

https://efiling.dir.ca.gov/PWCR/Search.action

II. Please see the one-page section, “Senate Bill 854” in Part IV of the Bid

Proposal for more information about Senate Bill 854.

H. PLANHOLDERS LIST

The Planholders List is available 24 hours a day and can be obtained via the Bureau of Engineering’s web site at http://eng.lacity.org. Click on Contractors tab; and then click on PLANHOLDERS LIST link.

I. LOCAL BUSINESS PREFERENCE PROGRAM

This project is subject to the provisions of the City’s Local Business Preference Program. Los Angeles Administrative Code Division 10, Chapter 1, Article 4, Section

10.25 adopted the Local Business Preference (LBP) Program which was designed to increase local employment and expenditures in the local private sector. All Bidders are eligible to participate in the LBP Program. The City shall grant a six percent (6%) bid reduction of their Bid amount solely for Bid evaluation purposes to those bidders who are certified as a Local Business Enterprise (LBE) firm. If the LBE is also a Local Small Business (LSB) and/or Local Transitional Employer (LTE), they may be granted an

SIDEWALK REPAIR PROGRAM PACKAGE NO. 86 (LA 28) - W.O. E1909515

https://efiling.dir.ca.gov/PWCR/Search.action http://eng.lacity.org/

Rev. 02/22/2022 Page 4 of 5 additional two percent (2%) reduction for each of those certifications, up to a total of ten percent (10%). The City shall grant a ten percent (10%) bid reduction of their Bid amount solely for Bid evaluation purposes to those Bidders who are certified as a City Business Enterprise (CBE) firm. If the CBE is also a LSB and/or LTE, they may be granted an additional two percent (2%) reduction for each of those certifications, up to a maximum of twelve percent (12%). Additionally, all non-LBE/CBE Bidders may be granted a one percent (1%) bid reduction of their Bid amount solely for Bid evaluation purposes, up to a maximum of five percent (5%), for every ten percent (10%) of their bid that is to be performed by a LBE, CBE, LSB and/or LTE subcontractor.

J. IRAN CONTRACTING ACT OF 2010

In accordance with California Public Contract Code Sections 2200-2208, all bidders submitting proposals for entering into or renewing contracts with the City of Los Angeles for goods and services estimated at $1,000,000 or more are required to complete, sign and submit the “Iran Contracting Act of 2010 Compliance Affidavit.”

K. ELECTRONIC SIGNATURE POLICY

(Types of Documents Permitted for Electronic and Scanned Signature)

This Policy is intended to broadly support the use of electronic signatures.

Departments are encouraged to consult with the City Attorney’s Office if Departments are uncertain if the electronic/scanned signature is acceptable for a document.

However, below are examples of the types of documents where electronic/scanned signatures are allowed:

1. Memos, forms, board letters and other correspondence Electronic/Scanned

2. Contracts Electronic/Scanned

3. Certificates and Permits Electronic/Scanned

4. Notarized Document Scanned

Please note that Ethics Form 50 and 55 must be signed via a software that is accepted by the Ethics Commission (i.e. DocuSign, Adobe). (Issued March 19, 2020)

L. BUY CLEAN CALIFORNIA ACT (BCCA)

I. For projects with a bid due date on or after July 1, 2021 that include eligible materials as part of the permanent work, the successful bidder shall be required to provide current facility-specific Environmental Product Declaration (EPD) for the materials and meet the State of California maximum limits for Global Warming Potential as listed by California's Department of General Services with the applicable submittal.

https://www.dgs.ca.gov/PD/Resources/Page-Content/Procurement-Division- Resources-List-Folder/Buy-Clean-California-Act

II. Please see the two-page section, “Buy Clean California Act Implementation” in Part IV of the Bid Proposal for more information about Buy Clean California Act.

https://www.dgs.ca.gov/PD/Resources/Page-Content/Procurement-Division-%20%20%20%20%20%20%20%20%20%20%20Resources-List-Folder/Buy-Clean-California-Act https://www.dgs.ca.gov/PD/Resources/Page-Content/Procurement-Division-%20%20%20%20%20%20%20%20%20%20%20Resources-List-Folder/Buy-Clean-California-Act

Rev. 02/22/2022 Page 5 of 5

THE DOCUMENTS CONTAINED HEREIN HAVE BEEN APPROVED BY:

Arsen Voskerchyan, P.E.

Division Engineer Project Award and Control Division Bureau of Engineering

PART I

Print and submit with your bid Part I single-sided only except for the “Equal Benefits Ordinance Affidavit” which will be submitted on RAMP.

1-1 Rev. 9/20/2017

PART I OF IV

SIDEWALK REPAIR PROGRAM PACKAGE NO. 86 (LA 28)

W.O. E1909515

In and for the City of Los Angeles

California

TYPE OF CONTRACT CASH

PROPOSAL ATTACHMENTS Plan Drawings: Index No. D-35991 (117 sheets)

SPECIFICATIONS General Conditions, General Requirements, Technical Specifications, Standard Specifications for Public Works Construction (Greenbook) 2012, 2014, 2017, and 2021 Edition* as amended by the City's Brown Book, May 4, 2022 Edition*.

PROJECT LOCATION See Plan Drawings

COMPLETION TIME 280 Calendar Days

LIQUIDATED DAMAGES $1,000 per Calendar Day

BID DATE

Bids must be received no later than 10:00 a.m. on September 2, 2026, at Los Angeles City Hall, 200 North Spring Street, Room 355; Los Angeles, California 90012. Call the Board Office at (213) 978-0262 if you have difficulties gaining access to City Hall.

Firm Name:

Address:

Telephone Number: ( ) Fax Number: ( )

Email Address:

Contractor's License Number: Classification: Expiration Date:

Business Tax Registration Certificate (BTRC) No.:

* Part 1 of the Greenbook and Brown Book are not a part of the Specifications.

ITEM DESCRIPTION UNIT QTY. UNIT PRICE ITEM TOTAL

1 MOBILIZATION

EA

SITE

2 TRAFFIC CONTROL AND PERMITS

EA

SITE

3 TEMPORARY DRAINAGE INLET PROTECTION

EA

SITE

4 REMOVE SIDEWALK SF 37,994

5 REMOVE CURB LF 914

6 REMOVE CURB AND GUTTER LF 1,022

7 REMOVE DRIVEWAY SF 8,802

8 REMOVE ASPHALT SF 6,631

9 EXCAVATION CY 861

10 4 INCH SIDEWALK AND DRIVEWAY SF 34,899

11 CONCRETE CURB LF 1,286

12 CONCRETE CURB AND GUTTER LF 1,138

13 4 INCH DRIVEWAY AND SIDEWALK EARLY HIGH STRENGTH SF 108

14 6 INCH DRIVEWAY AND SIDEWALK SF 7,205

16 4" PATTERNED / DECORATIVE / BRICK SIDEWALK & DRIVEWAY SF 1,982

18 CURB RAMP (ADA COMPLIANT) EA 17

20 UNTREATED BASE MATERIAL CY 475

21 ASPHALT CONCRETE SF 6,330

26 TREE ROOT PRUNING / SHAVING (PER TREE) EA 88

27 TREE CANOPY PRUNING (PER TREE) EA 84

28 INSTALL ROOT CONTROL BARRIER LF 56

29 REMOVE METAL TREE WELL GRATES EA 2

31 MODIFY EXISTING IRRIGATION SYSTEM

EA

SITE

32 TOP SOIL SF 3,477

34 TREE & STUMP REMOVAL (OVER 24 INCHES DIAMETER) EA 2

35 EXISTING STUMP REMOVAL EA 2

36 FURNISH & PLANT 24" BOX SIZE TREE EA 6

38 ADJUST UTILITY MAINTENANCE HOLE TO GRADE EA 5

W.O. E1909515

SCHEDULE OF WORK AND PRICES

City of Los Angeles - Department of Public Works - Bureau of Engineering

SIDEWALK REPAIR PROGRAM PACKAGE NO. 86 (LA 28)

1-2a

ITEM DESCRIPTION UNIT QTY. UNIT PRICE ITEM TOTAL

SCHEDULE OF WORK AND PRICES

City of Los Angeles - Department of Public Works - Bureau of Engineering

SIDEWALK REPAIR PROGRAM PACKAGE NO. 86 (LA 28)

39 ADJUST UTILITY PULLBOX TO GRADE EA 25

40 ADJUST UTILITY VAULT TO GRADE EA 2

41 ADJUST WATER / GAS METER / VENT TO GRADE EA 22

45 FURNISH & INSTALL TRAFFIC SIGNAL PULLBOX WITH LID (TYPE 2) EA 2

55 FURNISH & INSTALL STEEL WATER METER LID (NO 3) EA 1

63 STREET SIGN (REMOVE & REINSTALL) EA 13

68 4" DIAMETER SCHEDULE 80 PVC PIPE LF 349

70 RECTANGULAR METAL PIPE LF 14

71 ADJUST GRATE INLET EA 2

72 CLEARING AND GRUBBING EA 6

73 CONSTRUCT CONCRETE PAVEMENT SF 3,302

74 RELOCATE TELECOMMUNICATIONS PULLBOX EA 2

75 REMOVE AND CONSTRUCTION CONCRETE INTERSECTION GUTTER SF 236

76 REMOVE AND RELOCATE FENCE LF 135

77 REMOVE AND REPLACE ROLL GATE AND TRACK EA 1

78 REMOVE ARTIFICIAL GRASS SF 236

79 REMOVE BRICK PAVER SF 46

80 REMOVE CONCRETE PAVEMENT SF 2,729

Allowance for Removal, Relocation and/or Adjustment of Unknown Substructures/Utilities (GR Section 01212 and 01253)

$100,000.00

Allowance for Traffic Control Plan and TCTMC (Transportation Construction Traffic Management Committee) Traffic Requirements (GR Section 01212)

$50,000.00

Unit abbreviation: EA = EACH, CY = CUBIC YARD, LF = LINEAR FEET, LS = LUMP SUM, SF = SQUARE FEET

NOTES

C. SPECIALTY ITEMS: Bid Items Nos. 2-9, 16, 21, 26-29, 31, 32, 34-36, 39-41, 45, 63, and 73-82. are designated as

"Specialty Items."

A. MOBILIZATION: If the successful bidder shows an amount in excess of $85,500 for Mobilization (Bid Item No. 1), the bidder will be paid $85,500 per Specification Section 01292 of the General Requirements. The difference between the

Contractor’s bid amount for Bid Item No. 1 and $85,500 will be paid after the Statement of Completion has been issued.

B. FIXED COST ITEMS: Bid Item Nos. 81 and 82 are considered Fixed Cost Items at the time of bid. The pre-printed dollar amounts in figures listed in the SCHEDULE OF WORK AND PRICES shall not be changed or deleted.

TOTAL BID AMOUNT:

1-2b

C O N S T R U C T I O N

Responsibility Questionnaire (rev 1/23/2020) 1

CITY OF LOS ANGELES

CONTRACTOR RESPONSIBILITY ORDINANCE (CRO) QUESTIONNAIRE

Unless otherwise exempt from the Contractor Responsibility Ordinance (Los Angeles Administrative Code Section 10.40, et. seq.), a Company/Firm bidding with the City of Los Angeles must complete this Questionnaire. If no bid is required, the prospective contractor still must submit a Questionnaire.

The signatory for this Questionnaire must be authorized to respond to these questions on behalf of the Company/Firm. Any false or misleading statement(s), the failure to answer any of the required questions, or the failure to submit the completed Questionnaire with its bid may render the bid/proposal non-responsive. If a response does not fit in the space provided, then you may submit an attachment with your questionnaire.

The Company is responsible for keeping the Questionnaire responses current. If any changes have occurred that would render any of the responses inaccurate in any way, this document must be updated within thirty

(30) days of the change(s).

A. BIDDER / PROPOSER / PROSPECTIVE CONTRACTOR CONTACT INFORMATION

Business Name Contractor’s License Number

Street Address City State Zip

Contact Person, Title Phone Fax

TYPE OF SUBMISSION:

The Questionnaire being submitted is:

An initial submission of a completed Questionnaire.

An update of a prior Questionnaire dated ______/______/______.

No change. I certify under penalty of perjury under the laws of the State of California that there has been no change to any of the responses since the last Questionnaire dated ____/______/____ was submitted by the firm.

B. BUSINESS ORGANIZATION / STRUCTURE

Indicate the organizational structure of your firm. “Firm” includes a sole proprietorship, corporation, joint venture, consortium, association, or any combination thereof.

Corporation: Date incorporated: _____/_____/_____ State of incorporation:

List the corporation’s current officers.

President: __________________________________________________________________________ Vice President: ______________________________________________________________________ Secretary: __________________________________________________________________________ Treasurer:

1-3a

Responsibility Questionnaire (rev 1/23/2020) 2

List all the stock owners who own 5% or more of the corporation’s stock. Publicly traded corporations do not need to list its stock owners.

(Use this space. If you need additional space, you can attach a document)

Partnership: Date formed: _____/_____/_____ State of formation: ____________ List all partners in your firm.

(Use this space. If you need additional space, you can attach a document)

Sole Proprietorship: Date started: _____/_____/_____ List any firm(s) that you have been associated with as an owner, partner, or officer for the last five years. Do not include ownership of stock in a publicly traded company in your response to this question.

(Use this space. If you need additional space, you can attach a document)

Joint Venture: Date formed: _____/_____/_____

(1) List each firm that is a member of the joint venture and (2) List the percentage of ownership the firm will have in the joint venture. NOTE: Each member of the Joint Venture must complete a separate Questionnaire for the Joint Venture’s submission to be considered a responsive bid.

(Use this space. If you need additional space, you can attach a document)

C. OWNERSHIP AND NAME CHANGES

1. Is your firm a subsidiary, parent, holding company, or affiliate of another firm?

Yes No

If Yes, explain the relationship between your firm and the associated firm(s). Include information about an affiliated firm only if one firm owns 50% or more of another firm, or if an owner, partner or officer of your firm holds a similar position in another firm.

(Use this space. If you need additional space, you can attach a document)

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Responsibility Questionnaire (rev 1/23/2020) 3

2. Have any of your firm’s owners, partners, or officers operated a similar business in the past five years?

Yes No

If Yes, list the names and addresses of all such businesses, and the person who operated the business. Include information about a similar business only if an owner, partner or officer of your firm holds a similar position in another firm.

(Use this space. If you need additional space, you can attach a document)

3. Has your firm changed names in the past five years?

Yes No

If Yes, list all prior names, addresses, and the dates they were used. Explain the reason for each name change in the last five years.

(Use this space. If you need additional space, you can attach a document)

4. Are any of your firm’s contractor licenses held in the name of a corporation or partnership?

Yes No

If Yes, list the name of the corporation or partnership that actually holds the license.

(Use this space. If you need additional space, you can attach a document)

D. FINANCIAL RESOURCES AND RESPONSIBILITY

5. In the past five years, has your firm ever been denied construction bonding?

Yes No

If Yes, explain the circumstances surrounding each instance.

(Use this space. If you need additional space, you can attach a document)

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Responsibility Questionnaire (rev 1/23/2020) 4

6. Is your firm now, or has it been at any time in the last five years, the debtor in a bankruptcy case?

Yes No

If Yes, explain the circumstances surrounding each instance.

(Use this space. If you need additional space, you can attach a document)

7. Is your firm in the process of, or in negotiations toward, being sold or dissolved?

Yes No

If Yes, explain the circumstances.

(Use this space. If you need additional space, you can attach a document)

E. INSURANCE

8. In the past five years, has any bonding company made any payments to satisfy any claims made against a bond issued on your firm’s behalf?

Yes No If Yes, explain the circumstances surrounding each instance.

(Use this space. If you need additional space, you can attach a document)

9. Indicate the status of your firm’s current workers’ compensation insurance policy (check one):

Workers’ Compensation Insurance Policy Currently in Effect Legally Self-Insured No Workers’ Compensation Policy Currently in Effect*

*If you do not have a worker’s compensation insurance policy currently in effect, and you are not legally self-insured, provide an explanation.

(Use this space. If you need additional space, you can attach a document)

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Responsibility Questionnaire (rev 1/23/2020) 5

10. List the Experience Modification Rate (EMR) issued to your firm annually by your workers’ compensation insurance carrier for the last three years. Begin with the most recent year (YR 1) that an EMR rate was issued (EMR -1). If any of the rates for the three years is or was 1.00 or higher, provide an explanation below.

YR. 1: EMR-1: YR 2: EMR-2: YR. 3: EMR-3:

(Use this space. If you need additional space, you can attach a document)

11. Within the past five years, has your firm employed workers that were not covered under workers’ compensation insurance or state approved self-insurance?

Yes No

If Yes, explain each instance. If No, attach a statement from your workers’ compensation insurance provider that you have been continuously insured for the past five years.

(Use this space. If you need additional space, you can attach a document)

F. PERFORMANCE HISTORY

12. How many years has your firm been in operation? _______ Years.

13. Has your firm ever entered into any contract with the City of Los Angeles or any of its departments?

Yes No

If, Yes, list all contracts your firm has had with the City of Los Angeles for the last five (5) years. If your firm has had more than 10 contracts with the City of Los Angeles, then use the 10 most recent (and most similar) contracts. For each contract listed in response to this question, include: (a) entity name; (b) name of a contact and phone number; (c) purpose of contract; (d) total cost; (e) starting date; and (f) ending date.

(Use this space. If you need additional space, you can attach a document)

14. List all contracts that require similar work as the current bid/proposal in which your firm has had with any private or governmental entity (other than the City of Los Angeles) over the last five years. If your firm has had more than 10 contracts with similar work with any private or other governmental entities, then use the 10 more recent (and most similar) contracts. For each contract listed in response to this question, 1-3e

Responsibility Questionnaire (rev 1/23/2020) 6 include: (a) entity name; (b) name of a contact and phone number; (c) purpose of contract; (d) total cost;

(e) starting date; and (f) ending date.

(Use this space. If you need additional space, you can attach a document)

15. In the past five years, has a governmental or private entity or individual terminated your firm’s contract prior to its completion?

Yes No If Yes, explain the circumstances surrounding each instance.

(Use this space. If you need additional space, you can attach a document)

16. In the past five years, has your firm previously hired a debarred subcontractor to perform work on a government contract?

Yes No If Yes, explain the circumstances surrounding each instance.

(Use this space. If you need additional space, you can attach a document)

17A. In the past five years, has your firm been debarred or determined to be a non-responsible bidder or contractor?

Yes No

If Yes, explain the circumstances surrounding each instance.

(Use this space. If you need additional space, you can attach a document)

17B.. Has your firm ever received a Notice of Unsatisfactory Performance by the Bureau of Contract Administration pursuant to the City Contractor’s Performance Evaluation Ordinance (LAAC Section 10.39)?

Yes No

If Yes, please enter the date of the Notice(s).

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Responsibility Questionnaire (rev 1/23/2020) 7

G. DISPUTES

18A. In the past five years, has your firm been a defendant in a court case or other legal proceeding on a matter related to any of the following issues? For parts (a) and (b) below, check Yes even if the matter only proceeded to arbitration, mediation or other dispute resolution process. For part (c), check Yes only if the matter proceeded to court litigation, even if the case was later settled or dismissed.

(a) Payment to subcontractors?

Yes No

(b) Work performance on a contract?

Yes No

(c) Employment-related litigation brought by an employee?

Yes No

18B. If you answer Yes to any of the questions below, explain the circumstances surrounding each instance.

For each instance, you must include the following in your response: the name of the plaintiff(s), the specific cause(s) of action or claim(s), the original date of filing; and the disposition/current status.

(Use this space. If you need additional space, you can attach a document)

19. Does your firm have any outstanding judgments pending against it?

Yes No

If Yes, explain the circumstances surrounding each instance.

(Use this space. If you need additional space, you can attach a document)

20. In the past five years, has your firm been assessed liquidated damages on a contract?

Yes No

If Yes, explain the circumstances surrounding each instance and identify all the projects for which liquidated damages were assessed, the amount of liquidated damages assessed and paid, and the name and address of the project owner.

(Use this space. If you need additional space, you can attach a document)

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Responsibility Questionnaire (rev 1/23/2020) 8

H. COMPLIANCE

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

21A. In the past five years, has your firm or any of its owners, partners or officers, ever been investigated, cited, assessed any penalties, or been found to have violated any laws, rules, or regulations enforced or administered, by any of the governmental entities listed on page 12:

Yes No

21B. If Yes, explain the circumstances surrounding each instance, including the governmental entity or entities that were involved, the dates of such instances, and the outcome.

(Use this space. If you need additional space, you can attach a document)

22. Within the past five years, has your firm, or any person employed by your firm, been investigated, found to have violated, cited, assessed any penalty, or been subject to any disciplinary action by a licensing agency for violation of any licensing law, rule or regulation?

Yes No

If Yes, explain the circumstances surrounding each instance in the last five years.

(Use this space. If you need additional space, you can attach a document)

23. In the past five years, has your firm, any of its owners, partners, or officers, been penalized or given a letter of warning by the City of Los Angeles for failing to obtain authorization from the City for the substitution of a Minority-owned (MBE), Women-owned (WBE), or Other (OBE) business enterprise?

Yes No If Yes, explain the circumstances surrounding each instance in the last five years.

(Use this space. If you need additional space, you can attach a document)

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Responsibility Questionnaire (rev 1/23/2020) 9

24A. Provide the name(s), address(s) and telephone number(s) of the apprenticeship program sponsor(s) approved by the California Division of Apprenticeship Standards that will provide apprentices to your company for use on any public works projects that you are awarded by the City of Los Angeles.

(Use this space. If you need additional space, you can attach a document)

Provide the name(s), address(s) and telephone number(s) of the apprenticeship program sponsor(s) approved by the California Division of Apprenticeship Standards that have provided apprentices to your company on any public works project on which your firm has participated within the last 3 years.

(Use this space. If you need additional space, you can attach a document)

I. BUSINESS INTEGRITY

For the following questions, the term “firm” includes any owner, partner, or officer in the firm. If your firm is a publicly traded corporation, the term “owner(s)” does not include its stock owners.

25A. For questions (a), (b), and (c) below, check Yes if the situation applies to your firm.

(a) Is a governmental entity or public utility currently investigating your firm for making a false claim or material misrepresentation?

Yes No

(b) In the past five years, has a governmental entity or public utility alleged or determined that your firm made a false claim or material misrepresentation?

Yes No

(c) In the past five years, has your firm been convicted of, or found liable in a civil suit for, making a false claim or material misrepresentation to any governmental entity or public utility?

Yes No

25B. If you check Yes to any of the three questions above, explain the circumstances surrounding each instance of a false claim or material misrepresentation.

(Use this space. If you need additional space, you can attach a document)

26. In the past five years, has your firm or any of its owners or officers been convicted of a crime involving the

24B.

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Responsibility Questionnaire (rev 1/23/2020) 10 bidding of a government contract, the awarding of a government contract, the performance of a government contract, or the crime of theft, fraud, embezzlement, perjury, or bribery?

Yes No

If Yes, explain the circumstances surrounding each instance.

(Use this space. If you need additional space, you can attach a document)

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Responsibility Questionnaire (rev 01/23/2020) 11

TERMS OF ACCEPTANCE AND SIGNATURE:

I certify under penalty of perjury under the laws of the State of California that I read and understand the questions contained in this questionnaire and the responses contained herein and on all Attachments. I further certify that I have provided full and complete answers to each question, and that all information provided in response to this Questionnaire is true and accurate to the best of my knowledge and belief.

Electronic Signature:

Signature Date

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.

Execution of document by E-signature. By clicking on the check box, it indicates an electronic signature.

This is considered to be the legal equivalent of a manual or “wet” signature. Once signed electronically, this document is considered original and legally binding.

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Responsibility Questionnaire (rev 01/23/2020) 12

ATTACHMENT A: GOVERNMENTAL ENTITIES FOR QUESTION NO. 21A

Check Yes in response to Question No. 21A if your firm or any of its owners, partners or officers, have ever been investigated, cited, assessed any penalties, or found to have violated any laws, rules, or regulations enforced or administered, by any of the governmental entities listed below (or any of its subdivisions), including but not limited to those examples specified below. The term “owner” does not include owners of stock in your firm if your firm is a publicly traded corporation. If you answered Yes, provide an explanation of the circumstances surrounding each instance, including the entity involved, the dates of such instances, and the outcome.

FEDERAL ENTITIES

Federal Department of Labor

• American with Disabilities Act

• Immigration Reform and Control Act

• Family Medical Leave Act

• Fair Labor Standards Act

• Davis-Bacon and laws covering wage requirements for federal government contract workers

• Migrant and Seasonal Agricultural Workers

Protection Act

• Immigration and Naturalization Act

• Occupational Safety and Health Act

• anti-discrimination provisions applicable to government contractors and subcontractors

• whistleblower protection laws

Federal Department of Justice

• Civil Rights Act

• American with Disabilities Act

• Immigration Reform and Control Act of 1986

• bankruptcy fraud and abuse

Federal Department of Housing and Urban Development (HUD)

• anti-discrimination provisions in federally subsidized/assisted/sponsored housing programs

• prevailing wage requirements applicable to HUD related programs

Federal Environmental Protection Agency

• Environmental Protection Act

National Labor Relations Board

• National Labor Relations Act

Federal Equal Employment Opportunity Commission

• Civil Rights Act

• Equal Pay Act

• Age Discrimination in Employment Act

• Rehabilitation Act

• Americans with Disabilities Act

STATE ENTITIES

California’s Department of Industrial Relations

• wage and labor standards, and licensing and registration

• occupational safety and health standards

• workers’ compensation self insurance plans

• Workers’ Compensation Act

• wage, hour, and working standards for apprentices

• any provision of the California Labor Code

California’s Department of Fair Employment and Housing

• California Fair Employment and Housing Act

• Unruh Civil Rights Act

• Ralph Civil Rights Act

California Department of Consumer Affairs

• licensing, registration, and certification requirements

• occupational licensing requirements administered and/or enforced by any of the Department’s boards, including the Contractor’s State Licensing Board

California’s Department of Justice

LOCAL ENTITIES

City of Los Angeles or any of its subdivisions for violations of any law, ordinance, code, rule, or regulation administered and/or enforced by the City, including any letters of warning or sanctions issued by the City of Los Angeles for an unauthorized substitution of subcontractors, or unauthorized reductions in dollar amounts subcontracted.

OTHERS

Any other federal, state, local governmental entity for violation of any other federal, state, or local law or regulation relating to wages, labor, or other terms and conditions of employment.

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CITY OF LOS ANGELES

PLEDGE OF COMPLIANCE WITH CONTRACTOR RESPONSIBILITY ORDINANCE

Los Angeles Administrative Code (LAAC) Section 10.40 et seq. (Contractor Responsibility Ordinance) provides that, unless specifically exempt, City contractors working under service contracts of at least $25,000 and three months, contracts for services and for purchasing goods and products that involve a value in excess of twenty-five thousand dollars ($25,000) and a term in excess of three months are covered by this Article; and construction contracts of any amount; public lessees; public licensees; and certain recipients of City financial assistance or City grant funds, shall comply with all applicable provisions of the Ordinance. Upon award of a City contract, public lease, public license, financial assistance or grant, the contractor, public lessee, public licensee, City financial assistance recipient, or grant recipient, and any its subcontractor(s), shall submit this Pledge of Compliance to the awarding authority.

The contractor agrees to comply with the Contractor Responsibility Ordinance and the following provisions:

(a) To comply with all federal, state, and local laws in the performance of the contract, including but not limited to laws regarding health and safety, labor and employment, wage and hours, and licensing laws, which affect employees.

(b) To notify the awarding authority within 30 calendar days after receiving notification that any governmental agency has initiated an investigation which may result in a finding that the contractor did not comply with any federal, state, or local law in the performance of the contract, including but not limited to laws regarding health and safety, labor and employment, wage and hours, and licensing laws, which affect employees.

(c) To notify the awarding authority within 30 calendar days of all findings by a governmental agency or court of competent jurisdiction that the contractor has violated any federal, state, or local law in the performance of the contract, including but not limited to laws regarding health and safety, labor and employment, wage and hours, and licensing laws which affect employees.

(d) If applicable, to provide the awarding authority, within 30 calendar days, updated responses to the Responsibility Questionnaire if any change occurs which would change any response contained within the Responsibility Questionnaire and such change would affect the contractor’s fitness and ability to continue the contract.

(e) To ensure that subcontractors working on the City agreement (including contractors or subcontractors of a public lessee, licensee, sublessee, or sublicensee that perform or assist in performing services on the leased or licensed premises) shall comply with all federal, state, and local laws in the performance of the contract, including but not limited to laws regarding health and safety, labor and employment, wage and hours, and licensing laws, which affect employees.

(f) To ensure that subcontractors working on the City agreement (including contractors or subcontractors of a public lessee, licensee, sublessee, sublicensee that perform or assist in performing services on the leased or licensed premises) submit a Pledge of Compliance.

(g) To ensure that subcontractors working on the City agreement (including contractors or subcontractors of a public lessee, licensee, sublessee, or sublicensee that perform or assist in performing services on the leased or licensed premises) shall comply with paragraphs (b) and (c).

Failure to complete and submit this form to the Awarding Authority may result in withholding of payments by the City Controller, or contract termination.

Company Name, Address and Phone Number

Signature of Officer or Authorized Representative Date

Print Name and Title of Officer or Authorized Representative

Awarding City Department Contract Number

SRIS/CRO-3, Pledge of Compliance (Rev. 5/07/2014)

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Revised February 2022 Los Angeles Municipal Code § 48.09(H), Los Angeles Administrative Code § 10.40.1 Page 1 of 1 ethics.lacity.org

This form must be submitted with your bid or proposal to the City department that is awarding the contract noted below. If you have questions about this form, please contact the Ethics Commission at (213) 978-1960.

Certification

I certify the following on my own behalf or on behalf of the entity named above, which I am authorized to represent:

A. I am applying for one of the following types of contracts with the City of Los Angeles:

1. A goods or services contract with a value of more than $25,000 and a term of at least three months;

2. A construction contract with any value and duration;

3. A financial assistance contract, as defined in Los Angeles Administrative Code § 10.40.1(h), with a value of at least $100,000 and a term of any duration; or

4. A public lease or license, as defined in Los Angeles Administrative Code § 10.40.1(i), with any value and duration.

B. I acknowledge and agree to comply with the disclosure requirements and prohibitions established in the Los Angeles Municipal Lobbying Ordinance if I qualify as a lobbying entity under Los Angeles Municipal Code § 48.02.

I certify under penalty of perjury under the laws of the City of Los Angeles and the state of California that the information in this form is true and complete.

Name Signature

Title Date

Original Filing Amendment: Date of Signed Original ________________. Date of Last Amendment _________________.

Email Address Phone Number

Address

Reference Number (Bid, Contract, or RAMP) Awarding Authority (Department awarding the contract)

Bidder Name

FORM

Bidder Certification

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07/12/17 1-4

SIGNATURE SHEET AND AFFIDAVIT

I/We, depose and say that I am/We are ________ _ ___ __ Insert Name(s)

__ of ________________________________________________ (Insert "Sole Owner", "Partner", "President", etc.) (Insert firm name and address of bidder)

Contractor's License No. License Classification Expiration Date .

who submit this proposal to the Board of Public Works and hereby declare:

(1) That I/We have read this proposal and have abided by and agree to the conditions herein and have carefully examined the project plans and read the specifications and I/We hereby propose to furnish all materials and do all the work required to complete the work in accordance with the plans and specifications, for the unit prices or lump sums named in the Schedule of Work and Prices. Furthermore, I/WE have read and understand Ordinance No. 173677 of the “Determination of Contractor Responsibility Policy” of the City of Los Angeles and I/WE understand my/our obligations under this policy as a bidder and as a contractor should this contract be awarded to my/our firm.

(2) That this proposal is genuine, and not sham or collusive, nor made in the interest or in behalf of any person not herein named, and that I/We have not directly or indirectly induced or solicited any other bidder to put in a sham bid, or any other person, firm or corporation to refrain from bidding, and that I/We have not in any manner sought by collusion to secure for myself/ourselves an advantage over any other bidder.

(3) This contract is expressly made for the benefit of the signatory parties only. It is not the intent of any of the signatory parties to create or discharge any duty, express or implied, to any party other than the signatory parties. Any benefit derived from this contract by a third party is unintended and incidental to the purpose for which this contract is made.

(4) That I/We as principal(s), acknowledge myself/ourselves as being bound by the accompanying Bid Bond when completed by the Surety.

(5) That I have read and understand the provisions of the Pollution Control – Sewage Spill Prevention and Response Requirements and the Board of Public Work’s Policy of “Zero Sanitary Sewer Overflows” requirements as contained in this Proposal. If awarded this contract, I/ We agree to furnish all of the materials, supplies, tools, equipment, labor and other services necessary for the containment and clean up of any sewage or other pollutants spills or leaks occurring during the performance of this contract. I/WE further agree to act immediately, without instructions from City staff, to contain and clean up any spill in any way involved with my/ our activities on this project without concern for who or what caused the spill.

ADDENDA - This proposal is submitted with respect to the changes to the contract included in Addenda numbers:

(Fill in Addenda received) __________,__________,__________,__________,__________,__________,__________, I/We certify or declare under penalty of perjury that the foregoing is true and correct, and that if only one signature is provided, it is provided in accordance with Note 8 in the General Instructions and Information for Bidders of this proposal.

1.

Name Signature Title Date

2.

Name Second Signature Title Date

Note: ALL SIGNATURES MUST BE PROPERLY COMPLETED AND WITNESSED

BY A NOTARY

06/02/16

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SIDEWALK REPAIR PROGRAM PACKAGE NO. 86 (LA 28)

BID BOND

(Not necessary when certified check or cashier's check accompanies bid)

We, the principal and undersigned Surety, acknowledge ourselves jointly and severally bound to the Department of Public Works of the City of Los Angeles, for an amount not less than ten percent (10%) of the total bid, to be paid to said Department if the proposal shall be accepted and the proposed contract awarded to the principal, and the principal shall fail to execute the contract within the time specified by the general instructions in the proposal; and to furnish the required faithful performance and labor and material bonds, within the time specified. It is hereby agreed that bid errors shall not constitute a defense to forfeiture, except as provided by the State of California Public Contracting Code Sections 5101 through 5105, or as they may be amended.

WITNESS our hands this ____________day of ______________________, 20_____.

By:

Print Name of Owner or President of

Corporation/Company Print Surety's Name

1.

Signature Surety Mailing Address (Line 1)

Title Mailing Address (Line 2)

Date Print Name

2.

Print Name Surety Signature

* Second Signature Title

Title

Date

* SECOND SIGNATURE MAY BE REQUIRED WITH BID. Failure to provide the required signatures with bid may render the bid nonresponsive. If only one signature is submitted for a corporation, the City must be furnished with the required signatures authorization with bid, or a current copy of the required signature authorization must be on file with the City. See note below.

NOTE: SIGNATURE OF THE AUTHORIZED AGENT OF THE SURETY MUST BE WITNESSED BY A NOTARY. If a bid bond is submitted on a form other than this form, the bid bond may not be acceptable. See Note 9 in the General Instructions and Information for Bidders of this proposal for more information.

(Rev. 07/19/11)

LIST OF SUBCONTRACTORS

Use pages 1-6 and 1-7 to list subcontractors including manufacturers, truckers and equipment rental companies.

Use page 1-8 to list vendors and/or suppliers and brokers.

To be eligible for award of this project, the Board of Public Works requires the bidder to subcontract a minimum of its bid, as discussed in the Mandatory Subcontracting Minimum (MSM) Requirement paragraph on the important Notice page of the Proposal, to any qualified available Subcontractor(s). Failure to list subcontractors and subcontracting amounts on pages 1-6 through 1-8 with the bid sufficient to meet or exceed the MSM may cause the bid to be rejected by the Board of Public Works as non-responsive.

In accordance with provisions pertaining to the listing of Subcontractors, the bidder shall list herein each first tier Subcontractor to whom it proposes to subcontract portions of the work in an amount in excess of 2 of 1% of the Contractor=s total bid or $10,000.00, whichever is greater, and the dollar value of each listed subcontract. However, the bidder must list any additional subcontractor and dollar value to the subcontract, regardless of amount, if the bidder wishes to have the subcontract amount credited toward meeting the MSM level of participation for this project. No MBE, WBE, SBE, EBE, or DVBE credit will be given unless the subcontractor and subcontracting amounts are listed on pages 1-6 through 1-8. Note the following when calculating the pledged levels of participation:

$ MSM credit will not be given to a joint venture partner listed as a…