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HomeMy WebLinkAboutMINUTES - 02272007 - C.28 SEL _ TO: � Contra BOARD OF SUPERVISORS, AS GOVERNING BOARD '�?�- �`-����' OF THE CANYON LAKES GEOLOGICAL HAZARD - ABATEMENT DISTRICT Costa FROM: MAURICE M. SHIU, PUBLIC WORKS DIRECTOR ''�. ..TC` -- y County OUK� DATE: February 27, 2007 Q, a SUBJECT: APPROVE and RATIFY the decision of the Canyon Lakes Geologic Hazard Abatement District (GRAD) Manager, Richard D. Short, Kleinfelder Inc., or designee, to execute and award a contract with Power Engineering Contractors Inc. in the amount of$529,048 to provide maintenance and repair services, Danville area. (Canyon Lakes GHAD Funds) (District III)Project No. 7761-6X5148 SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDED ACTION: APPROVE and RATIFY the decision of the Canyon Lakes GHAD General Manager,Richard D. Short,Kleinfelder Inc. or designee, to execute and award a contract with Power Engineering Contractors Inc. in an amount not to exceed$529,048.00 to provide maintenance and repair services for the Shoreline Repair Project on East Lakeshore Drive, San Ramon. FISCAL IMPACT: There is no impact to the County General Fund. All costs will be covered with revenue from the Canyon Lakes GHAD which is funded through assessments levied on properties within the GHAD Boundary. CONTINUED ON ATTACHMENT: x SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE t/ APPROVE OTHER SIGNATURE(S): d y ACTION OF BOOD N � yy APPROVED AS RECOMMENDED V1 OTHER VOTE OF PERVISORS: I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT ' COPY OF AN ACTION TAKEN AND ENTERED ON UNANIMOUS(ABSENT MINUTES OF THE BOARD OF SUPERVISORS ON THE AYES: NOES: DATE SHOWN. ABSENT: ABSTAIN: Contact: Warren Lai,Special Districts (313-2180) \Sp G:\SpDist\Board \SpDist\Board Orders\2007\02-27-07 Power Engineering Canyon Lakes ATTESTED GHAD.doc JOHN CULLEN, CVXK OF THE BOARD OF SUPERVISORS cc: County Administrator Assessor Auditor-Controller Community Development BY: DEPUTY County Counsel H.Heard,Special Districts r i w t VF 1 s w � SUBJECT: APPROVE and RATIFY the decision of the Canyon Lakes Geologic Hazard Abatement District (GHAD)Manager, Richard D. Short, Kleinfelder Inc., or designee, to execute and award a contract with Power Engineering Contractors Inc. in the amount of$529,048 to provide maintenance and repair services, Danville area. (Canyon Lakes GHAD Funds) (District III) Project No. 7761-6X5148 DATE: February 27, 2007 PAGE: 2 of 2 REASONS FOR RECOMMENDATIONS AND BACKGROUND: The lake at Canyon Lakes is surrounded by a shallow concrete shoreline retaining wall. The retaining wall has been undermined by erosion resulting in deterioration and overturning failure at several locations. Where the wall has deteriorated the ground surface behind the wall has receded due to erosion and landsliding. The project includes replacing 420 feet of the wall where deterioration has been the most severe along 10 private properties. A new deep sheet pile wall will be constructed to stabilize the shoreline and restore the properties to their prior condition. CONSEQUENCES OF NEGATIVE ACTION: Without the Board of Supervisors approval the wall and slope conditions will worsen impacting the developed shoreline area of adjacent improvements and structures located on ten properties. CONTRACT (Canyon Lakes Geologic Hazard Atiatcment Dishier Standard Form Construction Agreement) Standard Form for Contracts 1. SPECIAL TERMS. These special terms are incorporated below by reference. Parties: Public Agency-Canyon Lakes Geologic Hazard Abatement District Contractor: Power Engineering Contractors,Inc. 1501 Viking Street,Alameda,CA 94501 Effective Date: January 17,2007 Project Name,Number and Location: E.Lakeshore-Shoreline Repair Project Completion Time: 75 working days Public Agency's Agent: Kleinfelder,Inc. Contract Price: $529,048.00 Liquidated Damages: $250.00 per calendar day. 2. SIGNATURES&ACKNOWLEDGMENT. Public Agency: By Kleinfelder,Inc. General Manager Contractor, hereby also ce w ess of and compliance with Labor Code Sections 1861 and 3700. concerning Workers!- o ensation La By: (Designate offici cthe business) By: (Designate offi al caps ty in the business) Note to Contractor: For corporations,the contract must be signed by two officers. The first signature must be that of the chairman of the board, president or vice president; the second signature must be that of the corporate secretary, assistant secretary, chief financial officer or assistant treasurer. (Civil Code, Section 1190 and Corporations Code, Section 313.) The acknowledgment below must be signed by a Notary Public. CERTIFICATE OF ACKNOWLEDGMENT State of California ) ss. County of 9 LAME- � ) On the date written below, before me, the undersigned Notary Public, personally appeared the personUs signing above for Contractor,personally known to me(or proved to me on the basis of satisfactory evidence)to be the personLs)whose nameLs)is/are subscribed to the within instrument and acknowledged to me that be/site/they executed the same in his/her/their authorized capacity ies),and that by his/W/their signatureLs)on the instrument the person(s),or the entity upon behalf of which the person acted,executed the instrument. WITNESS my hand and official seal. Dated: 0)-,9-3-6 7 (Notary's Seal) KIMBERtY'A.E NI COMM. #:1488274 6(l`l t u ic) NOTARY PUB11C CALIFORNIA ALAMEDA COUNTY (Page 1 of 4) Oplrwn.E►pres N 7 - Y r� i � ., .f a _.. •� - � - 1 r , V 3. WORK CONTRACT CHANGES. (a) By their signatures in Section 2,effective on the above date, these parties promise and agree as set forth in this contract,incorporating by these references the material in Section 1,SPECIAL TERMS. (b) Contractor shall, at his own cost and expense, and in a workmanlike manner, fully and faithfully perform and complete the work;and will furnish all materials, labor,services and transportation necessary,convenient and proper in order fairly to perform the requirements of this contract,all strictly in accordance with the Public Agency's plans,drawings and specifications and in accordance with the accepted proposal. (c) The work can be changed only with Public Agency's prior written order specifying such change and its cost agreed to by the parties;and the Public Agency shall never have to pay more than specified in Section 7,PAYMENT,without such an order. 4. TIME:NOTICE TO PROCEED. Contractor shall start this work as directed in the specifications or the Notice to Proceed; and shall complete it as specified in Section 1,SPECIAL TERMS. 5. LIQUIDATED DAMAGES. If the Contractor fails to complete this contract and this work within the time fixed therefor, allowance being made for contingencies as provided herein, he becomes liable to the Public Agency for all its loss and damage therefrom; and because, from the nature of the case, it is and will be impracticable and extremely difficult to ascertain and fix the Public Agency's actual damage from any delay in performance hereof, it is agreed that Contractor will pay as liquidated damages to the Public Agency the reasonable sum specified in Section 1, SPECIAL TERMS, the result of the parties' reasonable endeavor to estimate fair average compensation therefore,for each calendar day's delay in finishing said work; and if the same be not paid,Public Agency may,in addition to its other remedies,deduct the same from any money due or to become due Contractor under this contract. If the Public Agency for any cause authorizes or contributes to a delay, suspension of work or extension of time,its duration shall be added to the time allowed for completion, but it shall not be deemed a waiver nor be used to defeat any right of the Agency to damages for non-completion or delay hereunder. Pursuant to Government Code Section 4215, the Contractor shall not be assessed liquidated damages for delay in completion of the work, when such delay was caused by the failure of the Public Agency or the owner of a utility to.provide for removal or relocation of existing utility facilities. 6. INTEGRATED DOCUMENTS. The plans, drawings and specifications or special provisions of the Public Agency's call for proposals, and Contractors accepted proposal for this work are hereby incorporated into this contract; and they are intended to cooperate, so that anything exhibited in the plans or drawings and not mentioned in the specifications or special provisions, or vice versa,is to be executed as if exhibited,mentioned and set forth in both,to the true intent and meaning thereof when taken all together; and differences of opinion concerning these shall be finally determined by Public Agency's Agent specified in Section 1,SPECIAL TERMS. 7. PAYMENT. (a) For his strict and literal fulfillment of these promises and conditions, and as full compensation for all this work,the Public Agency shall pay the Contractor the sum specified in Section 7,PAYMENTS,except that in unit price contracts that payment shall be for finished quantities at unit proposal prices. (b) The Contractor shall be paid for all work done through the 25th of the preceding calendar month, as determined by Public Agency,minus 10%thereof,but not until defective work and materials have been removed,replaced,and made good. 8. PAYMENTS WITHHELD. (a) The Public Agency or its Agent may withhold any payment, or because of later discovered evidence nullify all or any certificate for payment, to such extent and period of time only as may be necessary to protect the Public Agency from loss because of: (1) Defective work not remedied,or uncompleted work,or (2) Claims filed or reasonable evidence indicating probable filing,or (3) Failure to properly pay subcontractors or for material or labor,or (4) Reasonable doubt that the work can be completed for the balance then unpaid,or (5) Damage to another contractor,or (6) Damage to the Public Agency,other than damage due to delays. (b) The Public Agency shall use reasonable diligence to discover and report to the Contractor, as the work progresses, the materials and labor which are not satisfactory to it, so as to avoid unnecessary trouble or cost to the Contractor in making good any defective work or parts. (c) 35 calendar days after the Public Agency files its notice of completion of the entire work, it shall issue a certificate to the Contractor and may pay the balance of the contract price after deducting all amounts withheld under this contract, provided the contractor shows that all claims for labor and materials have been paid,no claims have been presented to the Public Agency based on acts or omissions of the Contractor, and no liens or withhold notices have been filed against the work or site, and provided there are not reasonable indications of defective or missing work or of late-recorded notices of liens or claims against Contractor. (Page 2 of 4) _. . . r'. .a:. � .. _ .. .. � ,. .. �� ._ .i .. .. �,._ ,.... .i :1. .. , ! '�.. . � ( v '. - . ',. _ 3 i_ � .. �t - .. 9. INSURANCE. (Labor Code Secs. 1860-61) On signing this contract,Contractor must give Public Agency (1) a certificate of consent to self-insure issued by the Director of Industrial Relations,or,(2) a certificate of Workers'Compensation insurance issued by an admitted insurer, or(3) an exact copy of duplicate thereof ceiiified by the Director or the insurer. Contractor is aware of and complies with labor Code Section 3700 and the Workers' Compensation Law. Said certificates shall name those entities or individuals listed in Section 3-1.06 of the Special Provisions. 10.BONDS. On signing this contract Contractor shall deliver to Public Agency for approval good and sufficient bonds with sureties, in amount(s) specified in the specifications or special provisions, guaranteeing his faithful performance of this contract and his payment for all labor and materials hereunder. 11.FAILURE TO PERFORM. If the Contractor at anytime refuses or neglects,without fault of the Public Agency or its agent(s),to supply sufficient materials or workmen to complete this agreement and work as provided herein,for a period of 10 days or more after written notice thereof by the Public Agency,the Public Agency may furnish same and deduct the reasonable expenses thereof from the contract price. 12.LAWS APPLY. General. Both parties recognize the applicability of various federal, state and local laws and regulations, especially Chapter l of Part 7 of the California Labor Code(beginning with Section 1720, and including Sections 1735, 1777.5, and 1777.6 forbidding discrimination) and intend that this agreement complies therewith. The parties specifically stipulate that the relevant penalties and forfeitures provided in the Labor Code,especially in Sections 1775 and 1813,concerning prevailing wages and hours,shall apply to this agreement as though fully stipulated herein. 13.SUBCONTRACTORS. Public Contract Code Sections 4100-4114 are incorporated herein. 14.WAGE RATES. (a) Pursuant to Labor Code Section 1773,the Director of the Department of Industrial Relations has ascertained the general prevailing rates of wages per diem, and for holiday and overtime work, in the locality in which this work is to be performed, for each;craft,classification,or type of workman needed to execute this contract,and said rates are as specified in the call for bids for this work and are on file with the Public Agency,and are hereby incorporated herein. (b) This schedule of wages is based on a working day of 8 hours unless otherwise specified;and the daily rate is the hourly rate ,multiplied by the number of hours constituting the working day. When less than that number of hours are worked,the daily wage rate is proportionately reduced,but the hourly rate remains as stated. (c) The Contractor, and all his subcontractors, must pay at least these rates to all persons of this work, including all travel, .,subsistence, and fringe benefit payments provided for by applicable collective bargaining agreements. All skilled labor not listed above must be paid at least the wage scale established by collective bargaining agreement for such labor in the locality where such work is being performed. If it becomes necessary for the Contractor or any subcontractor to employ any person in a craft, ,classification or type of work(except executive,supervisory,administrative,clerical or other non-manual workers as such)for which no minimum wage rate is specified,the Contractor shall immediately notify the Public Agency which shall apply from the time of the initial employment of the person affected and during the continuance of such employment. 15.HOURS OF LABOR. Eight hours of labor in one calendar day constitutes a legal day's work,and no workman employed at any time on this work by the Contractor or by any subcontractor shall be required or permitted to work longer thereon except as provided in Labor Code Sections 1810-1815. 16.APPRENTICES. Properly indentured apprentices may be employed on this work in accordance with Labor Code Sections 1777.5 and 1777.6,forbidding discrimination. 17.DESIRE TO PROMOTE ECONOMY OF CONTRA COSTA. The Public Agency desires to promote the industries and economy' of Contra Costa County, and the Contractor therefore is encouraged to use the products, workmen, laborers and mechanics of this County in every case where the price,fitness and quality are equal. 18.ASSIGNMENT. The agreement binds the heirs,successors,assigns,and representatives of the Contractor;but he cannot assign it in whole or in part, nor any monies due or to become due under it, without the prior written consent of the Public Agency and the Contractor's surety or sureties,unless they have waived notice of assignment. 19.NO WAIVER BY PUBLIC AGENCY. Inspection of the work and/or materials,or approval of work and/or materials inspected, or statement by any officer, agent or employee of the Public Agency indicating the work or any part thereof complies with the requirements of payments therefore or any combination of these acts, shall not relieve the Contractor of his obligation to fulfill this contract as prescribed;nor shall the Public Agency be thereby estopped from bringing any action for damages or enforcement arising from the failure to comply with any of the terms and conditions hereof. (Page 3 of 4) .«q .. - 20.HOLD HARMLESS AND INDEMNITY. (a) Contractor promises to and shall hold harmless and indemnify from the liabilities as defined in this section. (b) The indemnitees benefited and protected by this promise are those entities and individuals listed in Section 3-1.06 of the Special Provisions. (c) The liabilities protected against are any liability or claim for damage of any kind allegedly suffered, incurred or threatened because of actions defined below, including but not limited to personal injury, death, property damage, trespass, nuisance, inverse condemnation, patent infringement, or any combination of these, regardless of whether or not such liability, claim or damage was unforeseeable at any time before the Public Agency approved the improvement plans or accepted the improvements as completed,and including the defense of any suit(s)or action(s)at law or equity concerning these. (d) The actions causing liability are any act or omission (negligent or non-negligent)in connection with the matters covered by this contract and attributable to the contractor,subcontractor(s),or any officer(s),agent(s)or employees)of one or more of them. (e) Non-Conditions: The promise and agreement in this section is not conditioned or dependent on whether or not any indemnitee has prepared,supplied,or approved any plan(s),drawing(s),specification(s)or special provision(s)in connection with this work, has insurance or other indemnification covering any of these matters, or that the alleged damage resulted partly from any negligent or willful misconduct of any indemnitee. 21. EXCAVATION. Contractor shall comply with the provisions of Labor Code Section 6705,if applicable,by submitting to Public Agency a detailed plan showing the design of shoring,bracing,sloping,or other provisions to be made for worker protection from the hazard of caving ground during trench excavation. 22. RECORD RETENTION. Except for records delivered to Public Agency, Contractor shall retain, for a period of at least five years after Contractors receipt of the final payment under this contract, all records prepared in the performance of this contract or otherwise pertaining to the work,including without limitation bidding,financial and payroll records. Upon request by Public Agency, Contractor shall make such records available to Public Agency,or to authorized representatives of the state and federal governments, at no additional charge and without restriction or limitation on their use. 23. CONFLICT WITH BID. It is further expressly agreed by and between the parties hereto that should there be any conflict between the terms of this contract and the proposal of said Contractor, then this contract shall control and nothing herein shall be considered as an acceptance of said terms of said proposal conflicting herewith. 24. USE OF PRIVATE PROPERTY. Contractor shall not use private property for any purpose in connection with the work absent a prior,written agreement with the affected property owner(s). 25. RENTAL AND WAGE RATES. The statement of prevailing wages appearing in the Equipment Rental Rates and General Prevailing Wage Rates is hereby,specifically referred to and by this reference is made a part of this contract. G:\Forms\Contract Forms\Standard Form for Contracts over$50k.doc (Page 4 of 4) .. A - _.... ., __ .., .. . .. . ..... �.., ,... , __� . . ri ' � . . ' r. . . , . . r,. _ . . _ �., _ ,. .. -�� ., - - � � .;� � _ ,. .. ._.. 't r �' r .. � � _� a.coRD TM CERTIFICATE OF LIABILITY INSL_ANCE Date1M90DD/YR) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Heffernan insurance Brokers ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1350 Carlback Ave.,Suite 200 HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Walnut Creek,CA 94596 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone: 925-934-8500 Fax:925-934-8278 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: National Liability&Fire Power Engineering Contractors INSURER B: Allied Insurance Co. 1501 Viking Street,Suite 200 INSURER C: Alameda,CA 94501 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF CONTRACT OR OTHER DOCUMENT-WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/OD DATE MM/DD/YY) LIMITS GENERAL LIABILITY _ EACH OCCURRENCE $1,000,000 \ A X X COMMERCIAL GENERAL LIABILITY LSF000212007 01/01/07 01/01/08 DAMAGE TO RENTED $50000 PREMISES(Fs.Ocanerxa CLAIMS MADE X I OCCUR MED EXP(ANY ONE PERSON) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $$.2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG) $2,000,000 POLICYEa Loc Employee Benefits $1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMB $.11000'000 B X ANY AUTO BA7802455387 01/01/07 01/01/08 (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS - (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS - (Per accident) PROPERTY DAMAGE $ (Per Accident) GARAGE LIABILITY AUTO ONLY—EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $10,000,000 A OCCUR F-1 CLAIMS MADE LSF000222007 01/01/07 01/01/08 AGGREGATE $10,000.000 $ DEDUCTIBLE $ X RETENTION$25,000 $ WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS'LIABILITY TORY LIMITS OR ANY PROPIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? EL DISEASE-POLICY LIMIT $ If yes,describe under EL DISEASE-FA EMPLOYEE $ SPECIAL PROVISIONS below OTHER EACH OCCURRENCE $1.000,000 APROTECTION 81NDEMNITY HSF000132007 01/01/07 01/01/08 DEDUCTIBLE 55,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE:E.Lakeshore Drive-Shoreline Repair Project.Canyon Lakes Geologic Hazard Abatement District and Kleinfelder,Inc.;Its elected and appointed officers,employees, and volunteers are named as additional insured per attached endorsement. Insurance is Primary per attached endorsement. '10 days for non-payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10'DAYS WRITTEN Canyon Lakes Geologic Hazard Abatement District NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Atm: Richard D. Short REPRESENTATIVES. 4125 Blackhawk Plaza Circle AUTHORIZED REPRESENTATIVE Danville CA 94506 ACORD 25(2001/08) ©ACORD CORPORATION 1988 ,. a -. .. — , . .. ' _ .. ., -.. ENDORSEMENT NO.:1 EFFECTIVE: 1/1/07 A.M., ATTACHED TO AND FORMING PART OF POLICY NO.: LSF000212007 OF THE: Commercial Marine Liability Policy ISSUED TO: Power Engineering Contractors,Inc. ADDITIONAL ASSURED AND WAIVER OF SUBROGATION ENDORSEMENT Project: RE:E.Lakeshore Drive-Shoreline Repair Project. Named Person/Organization: Canyon Lakes Geologic Hazard Abatement District and Kleinfelder,Inc.;Its elected and appointed officers,employees, and volunteers It is agreed that the Company waives its right of subrogation against any person or organizations to whom the Named Assured is obligated by written contract to provide such waiver,but only to the extent of such obligation and only with respect to operations by or on behalf of the Named Assured or to the facilities of or used by the Named Assured. It is further agreed that to the extent that the Named Assured is obligated by written contract to name any person or organization as additional assureds hereunder, the Company agrees that such persons or organizations shall be considered as Additional Assureds but only with respect to operations performed by or on behalf of the Named Assured or to the facilities of or used by the Named Assured. ALL OTHER TERMS,CONDITIONS,LIMITATIONS AND EXCLUSIONS REMAIN UNCHANGED. AUTHORIZED SIGNATURE ENDORSEMENT NO.: 2 EFFECTIVE: 1/1/07 ATTACHED TO AND FORMING PART OF POLICY NO.: LSF000212007 OF THE: Commercial Marine Liability Policy ISSUED TO: Power Engineering Contractors,Inc. PRIMARY AND NON-CONTRIBUTORY INSURANCE It is understood and agreed that, when required by a written contract,this policy shall be the principal coverage as respects the liabilities of the Named Assured and any other insurance carried by an Additional Assured shall not be contributory as respects the liabilities of the Named Assured,nor shall the Additional Assured be responsible for any premium hereunder. ALL OTHER TERMS,CONDITIONS,LIMITATIONS AND EXCLUSIONS REMAIN UNCHANGED. AUTHORIZED SIGNATURE .� : :�: . . . . . - r , . � . .�� L:LK I HULULK UUFY NB STATE P.O. BOX 420807, SAN FRANCISCO,CA 9414270807 COMPENSATION INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 01-19-2007 GROUP: 000430 POLICY NUMBER: 0000130-2006 CERTIFICATE ID: 119 CERTIFICATE EXPIRES: 10-01-2007 10-01-2006/10-01-2007 CANYON LAKES GEOLOGIC HAZZARD NB ABATEMENT DISTRICT 4125 BLACKHAWK PLAZA CIR STE 103 DANVILLE CA 94506-4678 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. tTHORIZED REPRESENTATI PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-01-2006 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER POWER ENGINEERING CONTRACTORS, INC NB 1501 VIKING ST STE 200 ALAMEDA CA 94501 [TBT,CN] (REV.2-05) PRINTED : 01-19-2007 .� � � �.:.t� � � .. FAl f`HFUL PERFORMANCE BOND Bond No.6456854 Premium:$7,179.00 KNOW ALL MEN BY THESE PRESENT, THAT WHEREAS, the Canyon Lakes Geologic Hazard Abatement District, hereinafter designated the "Owner", has, on January 19, 2007, awarded to Power Engineering Contractors, Inc., hereinafter designated as the "Principal",a contract for the construction of the EAST LAKESHORE SHORELINE REPAIR PROJECT,Canyon Lakes,California. WHEREAS,said Principal is required under the terms of said contract to furnish a bond for the faithful performance of said contract. NOW, THEREFORE, WE, the PRINCIPAL and Safeco Insurance Company of America, 1390 Willow Pass Rd., Suite 900, Concord, CA 94520 (NAME AND ADDRESS OF SURETY) as Surety,are held-and firmly bound unto the Owner the penal sum of Five Hundred Twenty-Nine Thousand Forty-Eight and no/100 dollars($529,048.00)lawful money of the United States,for the payment of which sum well and truly to be made,we bind ourselves,our heirs,executors,administrators and successors,jointly and severally,firmly by these present. THE CONDITION OF THIS OBLIGATION IS SUCH, that if the above bonded Principal, his or its heirsi executors, administrators, successors, or assigns, shall in all things stand to and abide by, and well and truly keep faithfully perform the covenants, conditions, and agreements in the said contract and any alterations made as therein provided,on his or their part,to be kept and performed at the time and in the manner therein specified, and in all respects according to their true intent and meaning, then this obligation shall become null and void,otherwise it shall be and remain in full force and virtue and Principal and Surety, in the event suit is brought on this bond,will pay to the Owner such reasonable attorney's fees as shall be fixed by the court. As a condition precedent to the satisfactory completion of the said contract, the above obligation in the said amount shall hold good for a period of one (1)year after the completion and acceptance of the said work, during which time if the above bonded Principal, his or its heirs,executors, administrators, successors or assigns shall fail to make full,complete, and satisfactory repair and replacements or totally protect the said Owner in accordance with the Guaranty provision of said contract during said period of one year from the date of acceptance of said work, and resulting from or caused by defective materials and/or faulty workmanship in the prosecution of the work done;the above obligation in the said amount shall remain in full force and effect. And the said Surety,for value received,hereby stipulates and agrees that no change,extension of time,alteration,or addition of the terms of the contract or to the work to be performed thereunder or the specifications accompanying the same shall, in any way, affect its obligation of this bond,and it does hereby waive notice of any change,extension of time, alteration or addition to the terms of the contract or to the work or to the specifications. Said Surety hereby waives the provisions of Sections 2919 and 2845 of the Civil Code of the State of California. IN WITNESS WHEREOF,the above bonded parties have executed this instrument under their seals this 19th day of January, 2007, the name and corporate seal of each corporate party being hereto affixed and these presents duly signed by its undersigned representative, pursuant to authority of its governing body. Power En inee ' tra tors Inc. _ Principal (Seal) = = B Signature of Vrincipal Title of Signatory Safeco Insurance Company of America Sure 7B (Seal) Si ature of Sur ty Nancy L. Hamilton, Attorney-in-Fact Title of Signatory r .,, . ,,.. -. .. � -. .�„ �e .'� ".'. ..�., a ..... �:' .r !' .t .� ' .;t - � _ �1. i� ).. ... � .. =lr ..t _ <.7 ... - �4 CALIFORNIA ALL-PURPOSE-..CKNOWLEDGMENT State of California County of San Francisco On January 19, 2007 before me, Nerissa S. .Bartolome, Notary Public DATE NAME.TITLE OF OFFICER-E.G..'JANE DOE.NOTARY PUBLIC- personally appeared Nancy L. Hamilton. NAME(S)OF SIGNER(S) x❑ personally known to me - OR - ❑ proved to me on the basis of satisfactory evidence to be the pe•rson+&- whose name{st isfa-n—_ subscribed to the within instrument and ac- knowledged to me that *e/sheMw,7 executed the same in -h-i.s/her/the+F authorized �,.�./ capacity(ies), and that by 4a &/her/them NERISSAS.BgRTO01 si nature on the instrument the erson Commission*1428484 g p Notary Public-COVOOMW or the entity upon behalf of which the •"� Alamedacou* erson acted, executed the instrument. Mycomm Explres Jun 24,2007 p WITNESS my hand and official seal. SIGNATURE OF NOTARY OPTIONAL Though the data below is not required by law,it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT ❑ INDIVIDUAL ❑ CORPORATE OFFICER Bond No. 6456854 Power Engineering Contractors, Inc. TITLE OR TYPE OF DOCUMENT TITLE(S) - ❑ PARTNER(S) ❑ LIMITED ❑ GENERAL One (1) ATTORNEY-IN-FACT NUMBER OF PAGES ❑ TRUSTEE(S) ❑ GUARDIAN/CONSERVATOR ❑ OTHER: January 19, 2007 DATE OF DOCUMENT SIGNER IS REPRESENTING: NAME OF PERSON(S)OR ENTITY(IES) Safeco Insurance Company of America SIGNER(S)OTHER THAN NAMED ABOVE .. f � � � .+ .. Y y . _ 9.'. .. ._ � .`fi _ 1.. .. r.. ...,..�:... ..- POWER Safeco Insurance Companies MA PO Box 34526 Ry. PO 'ATTORNEY Seattle.WA 98124-1526 9437 No. KNOW ALL BY THESE PRESENTS: That SAFECO INSURANCE COMPANY OF AMERICA and GENERAL INSURANCE COMPANY OF AMERICA, each a Washington corporation,does each hereby appoint ******************NERISSA S.BARTOLOME;ROGER C.DICKINSON;ROSEMARIE GUANILL;NANCY L.HAMILTON; STANLEY D.LOAR;MARK M.MUNEKAWA;JEFFREY W.PARKHURST;CHARLES R.SHOEMAKER;San Francisco, California""' its true and lawful attorney(s)-in-fact,with full authority to execute on its behalf fidelity and surety bonds or undertakings and other documents of a similar character issued in the course of its business,and to bind the respective company thereby. IN WITNESS WHEREOF, SAFECO INSURANCE COMPANY OF AMERICA and GENERAL INSURANCE COMPANY OF AMERICA have each executed and attested these presents 28th September 2005 this day of ares STEPHANIE DALEY-WATSON.SECRETARY MIKE PETERS,PRESIDENT,SURETY CERTIFICATE Extract from the By-Laws of SAFECO INSURANCE COMPANY OF AMERICA and of GENERAL INSURANCE COMPANY OF AMERICA: "Article V,Section 13.-FIDELITY AND SURETY BONDS...the President,any Vice President,the Secretary,and any Assistant Vice President appointed for that purpose by the officer in charge of surety operations,shall each have authority to appoint individuals as attomeys-in-tact or under other appropriate titles with authority to execute on behalf of the company fidelity and surety bonds and other documents of similar character issued by the company in the course of its business...On any instrument making or evidencing such appointment, the signatures may be affixed by facsimile. On any instrument conferring such authority or on any bond or undertaking of the company, the seal, or a facsimile thereof, may be impressed or affixed or in any other manner reproduced; provided,however,that the seal shall not be necessary to the validity of any such instrument or undertaking." Extract from a Resolution of the Board of Directors of SAFECO INSURANCE COMPANY OF AMERICA and of GENERAL INSURANCE COMPANY OF AMERICA adopted July 28.1970. "On any certificate executed by the Secretary or an assistant secretary of the Company setting out, (i) The provisions of Article V,Section 13 of the By-Laws,and (ii) A:copy of the power-of-attorney appointment,executed pursuant thereto,and (iii) Certifying that said power-of-attorney appointment is in full force and effect, the signature of the certifying officer may be by facsimile,and the seal of the Company may be a facsimile thereof." 1,Stephanie Daley-Watson ,Secretary of SAFECO INSURANCE COMPANY OF AMERICA and of GENERAL INSURANCE COMPANY OF AMERICA,do hereby certify that the foregoing extracts of the By-Laws and of a Resolution of the Board of Directors of these corporations,and of a Power of Attorney issued pursuant thereto,are true and correct,and that both the By-Laws,the Resolution and the Power of Attorney are still in full force and effect. IN WITNESS WHEREOF,1 have hereunto set my hand and affixed the facsimile seal of said corporation this 19th day of Jantiary 2007 Go�RtTt � SJR 'Yyo .. y CORFORgE y ? Z"t SEAL w SEAL T �f y x - ai,�l F�W�SCaWds� ,s STEPHANIE DALEY-WATSON,SECRETARY Safeco®and the Safeco logo are registered trademarks of Safeco Corporation. S-0974/13S 4/05 WEB PDF { t; _ -. ,. �4 �� .. { CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT K)t { State of California ss. ? County of Alameda �z On January 23, 2007 before me, Kimberly A. Elam, Notary PUblic Date Name and Title of Officer(e.g.,'Jam Doe.Notary Publicl personally appeared Davi d Mi k )' Name(s)of Signer(s) [Xpersonally known to me ❑ proved to me on the basis of satisfactory evidence to be the personN whose nameN isrKe subscribed to the within instrument and t acknowledged to me that he/sMe/they executed ; the same in his/her/their authorized KIMBERLY A ELAII capacity(fes), and that by his/her/thsir COMM. L 1488274 signature(s) on the instrument the personN), or rgT4RvPUgLtC.UUidUM the entity upon behalf of which the persons) ALAMEDA C(XJNTY acted, executed the instrument. � Comm. 7OL f'S WITNESS y hand and official seal. ,. S' at a of No ubl { OPTIONAL $;, Though the information below is not required by law,it may prove valuable to persons retying on the document and could prevent lj fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: ` Signer(s)Other Than Named Above: Capacity(ies) Claimed by Signer Signer's Name: { ❑ Individual Top of thumb here ❑ Corporate Officer—Title(s): 4> ❑ Partner—❑ Limited ❑General x F ❑ Attorney-in-Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: M Signer Is Representing: c 01999 National Notary Association•9350 De Soto Ave.,P.O.Box 2402•Chatsworth,CA 91313-2402•www.nationainotaryorg Prod.No.5907 Reorder:Call Toll-Free 1.800-87E6827 ' � .'f'�';. ' .. .. ".. d i � � � s � � �� 'iii .. _ i .���� � •i'1 ,. r �.�� �ti: s I s ,, �. PAYMENT BOND PUBLIC WORK [Civ. Code §§ 3247-3248] Bond No. 6456854 Premium Included in Performance Bond Any claim under this Bond should be sent to the following address: Surety: Safeco Insurance Company of America 1390 Willow Pass Rd.,Suite 900 Concord,CA 94520 Obligee:Canyon Lakes Geologic Hazard Abatement District c/o Kleinfelder,Inc.,General Manager 4125 Blackhawk Plaza Circle,Suite 103 Danville,CA 9.4596 KNOW ALL MI---N BY THE PRESENTS: That we, Power Engineering Contractors,Inc. As Principal,and Safeco Insurance Company of America a corporation organized and existing under the laws of the State of Washington and authorized to transact surety business in the State of California, as Surety, are held and firmly bound unto CANYON LAKES GEOLOGIC HAZARD ABATEMENT DISTRICT, as Obligee, in the sum of Five Hundred Twenty-Nine Thousand Forty-Eight and no/100 Dollars($529,048.00) lawful money of the United States of America, for the payment of which sum well and truly to be made, we bind ourselves,our heirs,executors,administrators,successors and assigns,jointly and severally,firmly by these presents. THE CONDITION of the above obligation is such that,whereas the Principal has entered into a contract dated January 19,2007, with the Obligee to do and perform the following work,to wit: East Lakeshore Shoreline Repair Project,Canyon Lakes,California As is more specifically set forth in the contract documents,reference to which is hereby made. NOW, THEREFORE, if the Principal or a subcontractor fails to pay any of the person named in Section 3181 of the Civil Code, or amounts due under the Unemployment Insurance Code with respect to work or labor performed under the contract, or for any amounts required to be deducted, withheld and paid over to the Employment Development Department from the wages of.employees of the Principal and subcontractors pursuant to Section 13020 of the Unemployment Insurance Code, with respect to such work and labor, the Surety will pay for the same, in an amount not exceeding the sum specified in this bond,and also, in case suit is brought upon this bond,a reasonable attorney's fee,to be fixed by the court. This bond shall inure to the benefit of any of the persons named in Section 3181 of the Civil Code so as to give a right of action to such persons or their assigns in any suit brought upon this bond. SIGNED AND SEALED,this 19'h day of January,2007. Power Engineer m-_C ontractors,Inc. Safeco Insurance Company of America (Principal: _ (Surety) - By: _ By: Nancy L.Hahilton,Attorney-in-Fact (Signatu ) (Signature) (SEAL&ACKNOWLEDGEMENT OF NOTARY) (SEAL&ACKNOWLEDGEMENT OF NOTARY) See Attached Notarial Acknowledgement r .. _ CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California ss. f County of Alameda � t r; On January 23, 2007 before me, Kimberly A.Elam, Notary Public ("? Date Name and Title of Officer(e.g.,*Jane Doe,Notary Publics personally appeared David Mik t5 Names)of Signer(s) t? M personally known to me t� r ❑ proved to me on the basis of satisfactory evidence ;5 to be the person() whose name(s) is/ste t ' subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacityTiss), and that by his/her/their s Kl118ER1y�d signature(*&)on the instrument the person(n), or the entity upon behalf of which the person(,&) COMM. 1488274 ' NOTMY P11BW•CAUF M M ' ALAMEDA COUNTY acted, executed the instrument. i WITNESS y hand and official seal. ' s of A' OPTIONAL Though the information below is not required by law,it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. K� Description of Attached Document Title or Type of Document: r Document Date: Number of Pages: i Signer(s)'Other Than Named Above: Capacity(ies) Claimed by Signer ? ' Signer's Name: Top of thumb here El Individual G� ❑ Corporate Officer—Title(s): ❑ Partner—❑ Limited ❑General ❑ Attorney-in-Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: ' Signer Is Representing: 01999 National Notary Association•9350 De Soto Ave.,P.O.Box 2402•Chatsv Orth,CA 91313-2402•�_nationatnotaryorg Prod.No.5907 Reorder:Call Toll-Free 1-800-876.6827 . .. �.� ._ ,.. i. . . ����� • � i." .. . ._ . ,. , 1 aSafeco POWER® PO BoxI34526 nsurance Companies OF ATTORNEY Seattle,'WA 98124-1526 9437 KNOW ALL BY THESE PRESENTS: No. That SAFECO INSURANCE COMPANY OF AMERICA and GENERAL INSURANCE COMPANY OF AMERICA, each a Washington corporation,does each hereby appoint ******************NERISSA S.BARTOLOME;ROGER C.DICKINSON;ROSEMARIE GUANILL,NANCY L.HAMILTON; STANLEY D.LOAR;MARK M.MUNEKAWA;JEFFREY W.PARKHURST;CHARLES R.SHOEMAKER;San Francisco, California""t* its true and lawful attorney(s)-in-fact,with full authority to execute on its behalf fidelity and surety bonds or undertakings and other documents of a similar character issued in the course of its business,and to bind the respective company thereby. IN WITNESS WHEREOF, SAFECO INSURANCE COMPANY OF AMERICA and GENERAL INSURANCE COMPANY OF AMERICA have each executed and attested these presents 28th September 2005 this day of • STEPHANIE DALEY-WATSON.SECRETARY MIKE PETERS.PRESIDENT.SURETY CERTIFICATE Extract from the By-Laws of SAFECO INSURANCE COMPANY OF AMERICA and of GENERAL INSURANCE COMPANY OF AMERICA: E; "Article V,Section 13.-FIDELITY AND SURETY BONDS...the President,any Vice President,the Secretary,and any Assistant Vice President appointed for that purpose by the officer in charge of surety operations,shall each have authority to appoint individuals as attorneys-in-fact or under other appropriate titles with authority to execute on behalf of the company fidelity and surety bonds and other documents of similar character issued by the company in the course of its business...On any instrument making or evidencing such appointment, the signatures may be affixed by facsimile. On any instrument conferring such authority or on any bond or undertaking of the company, the seal, or a facsimile thereof, may be impressed or affixed or in any other manner reproduced; provided,however,that the seal shall not be necessary to the validity of any such instrument or undertaking." Extract from a Resolution of the Board of Directors of SAFECO INSURANCE COMPANY OF AMERICA and of GENERAL INSURANCE COMPANY OF AMERICA adopted July 28,1970. "On any certificate executed by the Secretary or an assistant secretary of the Company setting out, (i) The provisions of Article V,Section 13 of the By-Laws,and (ii) A`copy of the power-of-attomey appointment,executed pursuant thereto,and (iii) Certifying that said power-of-attomey appointment is in full force and effect, the signature of the certifying officer may be by facsimile,and the seal of the Company may be a facsimile thereof." [,Stephanie Daley-Watson Secretary of SAFECO INSURANCE COMPANY OF AMERICA and of GENERAL INSURANCE COMPANY OF AMERICA,do hereby certify that the foregoing extracts of the By-Laws and of a Resolution of the Board of Directors of these corporations,and of a Power of Attorney issued pursuant thereto,are true and correct,and that both the By-Laws.the Resolution and the Power of Attorney are still in full force and effect. IN WITNESS WHEREOF,1 have hereunto set my hand and affixed the facsimile seal of said corporation this 19th dayof January 2007 E CCORPORANTE t1Mp9�o SEAL y SEAL X a� 1953 192y lEOf °o(YVi1Se `� STEPHANIE DALEY-WATSON,SECRETARY Safeco®and the Safeco logo are registered trademarks of Safeco Corporation. S-0974/DS 4/05 WEB PDF i t .•. .. " .�. ...:, .. .s �., ... ,' ii a ;,, .t n .. , �. : � . , � .,,, .. .. ., .., i�� .,` . .- .. . . CALIFORNIA ALL-PURPOSE-.ACKNOWLEDGMENT State of California County of San Francisco On January 19, 2007 before me, Nerissa S. Bartolome, Notary Public DATE NAME,TITLE OF OFFICER-E.G..'JANE DOE.NOTARY PUBLIC' personally appeared Nancy L. Hamilton NAME(S)OF SIGNER(S) personally known to me - OR - ❑ proved to me on the basis of satisfactory evidence to be the person{' whose name{st is/�- subscribed to the within instrument and ac- knowledged to me that +te/sheA rey executed the same in J:l. s/her/the+F authorized capacity(ies), and that by 4&/he.r/theiF signatureW on the instrument the person(tt, or the entity upon behalf of which the NERLSMS.B3ARTOtt� erson acted, executed the instrument. _ Commisslon#1426484 p -� Notary Public-Calitomlo Alameda County ' My Comm.Expires Jun 24,2007 WITNESS my hand and official seal. 1' /P1J SIGNATURE OF NOTARY Xw U OPTIONAL Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT , ❑ INDIVIDUAL ❑ CORPORATE OFFICER Bond No. 6456854 Power Engineering Contractors, Inc. nrLE(s) TITLE OR TYPE OF DOCUMENT ❑ PARTNER(S) ❑ LIMITED ❑ GENERAL One (1) ATTORNEY-IN-FACT NUMBER OF PAGES ❑ TRUSTEE(S) ❑ GUARDIAN/CONSERVATOR ❑ OTHER: January 19, 2007 DATE OF DOCUMENT SIGNER IS REPRESENTING: NAME OF PERSON(S)OR ENTITY(IES) Safeco Insurance Company of America SIGNER(S)OTHER THAN NAMED ABOVE .^!1r .. a , 1 Form W'9 Request for Taxpayer Give form to the (Rev.November of the Treas2W5ury Identification Number and Certification requester.Do not Department of me Treasury send to the IRS. hNemal Revenue Service ni Name(as shown on your income tax return) C1. Business name,if di erent from abov c 0 m to G r� Individual/ Exempt from backup -%.2 Cheek appropriate box: d BoleproprietorOCorporation ❑ Partnership ❑ tither► ❑ --------------•-• -withholding Address(number,street,and apt.or suite no.) Requester's name and address(optional) /501 V a K1VVkkeAC4g.,lnc. city. te,and ZIP y 01 14(25 BtAckh—ti C>12.,5i-106 y List account number(s)here(optional) LO er FMM Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box The TIN provided must match the name given on Line 1 to avoid Social security number backup withholding.For individuals,this is your social security number(SSN).However,for a resident I I I } alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other entities,it is your employer identification number(EIN).If you do not have a number,see How to get a TIN on page 3. or Note.If the account is in more than one name,see the chart on page 4 for guidelines on whose E; ployer identification number number to enter. IDI-+I(012-151 FMTM Certification Under penalties of perjury,1 certify that: 1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me).and 2. I am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue Service(IRS)that 1 am subjert to backup withholding as a result of a faihue to report all interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding,and 3. 1 am a U.S. person(including a U.S.resident alien). Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply. For mortgage interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments other than interest and dividends,you are not required to sign the Certification,but you must provide your correct TIN.(Sef the instructions on page 4.) Sign Signature of Here 1U.S. on►. Date ► -25- 200 Purpose of Form • An individual who is a citizen or resident of the United A person who is required to file an information return with the States, IRS, must obtain your correct taxpayer identification number e A partnership, corporation,company, or association (TIN)to report,for example, income paid to you,real estate created or organized in the United States or under the laws transactions, mortgage interest you paid,acquisition or of the United States,or abandonment of secured property,cancellation of debt,or * Any estate(other than a foreign estate)or trust. See contributions you made to an IRA. Regulations sections 301.7701-6(a)and 7(a)for additional U.S. person.Use Form W-9 only if you are a U.S- person information. (including a resident alien), to provide your correct TIN to the Special rules for partnerships.Partnerships that conduct a person requesting it(the requester)and,when applicable,to: trade or business in the United States are generally required 1. Certify that the TIN you are giving is correct(or you are to pay a withholding tax on any foreign partners' share of waiting for a number to be issued), income from such business. Further, in certain cases where a 2. Certify that you are not subject to backup withholding,or Form W-9 has not been received, a partnership is required to 3presume that a partner is a foreign person, and pay the . Claim exemption from backup withholding if you area U.S.exempt payee. withholding tax.Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the In 3 above, if applicable,you are also certifying that as a United States, provide Form W-9 to the partnership to U.S. person,your allocable share of any partnership income establish your U.S.status and avoid withholding on your from a U.S. trade or business is not subject to the share of partnership income. withholding tax on foreign partners'.share of effectively connected income. The person who gives Form W-9 to the partnership for purposes of establishing its U.S.status and avoiding Note.If a requester gives you a form other than Form W-9 to withholding on its allocable share of net income from the request your TIN, you must use the requester's form if it is substantially similar to this Form W-9. partnership conducting a trade or business in the United States is in the following cases: For federal tax purposes,you are considered a person if you • The U.S. owner of a disregarded entity and not the entity, are: Cat.No.10231x Form W-9 (Rev.11-2(105) .. _ 1.. z - ;+�«�, s _..t _. y,. _ I . .. � r — � . .. .. � i . .. �. .'? Contra Costa County Self Certification Form Small Business Enterprise and Outreach Programs All of the non-statistical information provided in SECTION I will be included in the County's SBE and Outreach Directory,which may be shared with County Departments, contractors,consultants,and others in both electronic(internet, intranet,e-mail, facsimile)and paper formats, unless you indicate otherwise in SECTION S. Name of Firm(Print) IVtAc-WS, Inc. pyc Street Address(City,State) C a1a~q1,r_1 ( Pode) STI- Mailing Address(City,State) S Q ¢ /,(Zip Code) (Area Code)Phone No. IME-mail (Area Code)Fax 7_ 000 E .., 30 Is your main office located in Contra Costa County? Yes 0- No or Business Entity Status Check all appropriate boxes: MBE El WBE 13 DBE El SBE Ll LBE L3 DV13E Q OBE Q (See Page 3Yor Definitions) For Statistical Purposes Only Ethnicity of Owner(s): White Black 0 Hispanic L3 Asian Ll American Indian/Alaskan Native Q Complete this section to certify as a Small Business Enterprise. (See Page 3 for Definitions) State Certified SHE: Yes C]. No Certification No.: Have your gross receipts for the past three Y _years averaged$10 million or less Do you employ more than 100 employees t her eryear? es No GZ with affiliates? Yes No p Is your principal office located in California? Yes 9f No L3 The officers reside in California? Yes Gd No Cl ECTION Complete this section to certify as a Minority Business Enterprise (MBE)and/or Woman Business Enterprise(WBE) and/or Disabled Veteran Business Enterprise(DVBE) (See Page 3 for Definitions) Check appropriate box: Contractor El Special Trade Contractor L3 Trucker Q Manufacturer LI Construction Supplier Q Vendor 0 Consultant/Service Provider CI Are you certified with any other agencies: Yes No If"Yes"please list: 0- 0: If you are a Contractor,are your annual gross receipts fourteen million dollars($14,000,000)or less? Yes 0- No 0 If you area Special Trade Contractor,are your annual gross receipts seven million dollars($7.000,000)or'less? Yes ❑ No ❑ Ifyou are a Trucker/Manufacturer/Supplier/Vendor,do you meet the SBA size standard? Yes No (For the specific SBA size standard contact the Affirmative Action Office,(925)335-1045) Is your firm 51%owned and managed by one or more minority owners? Yes 0- No El: Is your firm 5l%owned and managed by one or more women owners? Yes Q No L1 Is your firm 51%owned and managed by one or more disabled veteran owners? Yes Ll No (3 Are the owners citizens or lawful permanent residents of the U.S.? Yes 0' No Q. if you area DVBE,is your principal office located in the United States? Yes 13 No L3 As a DYBE,do you reside in California? Yes LJ No L3 Revised 09/10104 a:SBEOutreachSelfCertification See Other Side Pagel of s : 1 - Contra Costa County Small Business Enterprise and Outreach Programs Self Certification Form ECTION Work Conducted By Firm(Describe what your firm does.) Construction COtnCKB{e, �WGd 5tti'UCtt)�t,$r dCbl tZy Iw5 411h US l4L Q/prK6j vt`�llon�slhspect'1(1y,�unalGtian S,Flood 3Ete�s,tnaCarilzol Vendor/Supplies A rll Consultand Eme tet C, 0M5VM Service Provider tetqJ ECTION Acknowledgement of Publication The undersigned acknowledges and agrees that the non-statistical information provided in SECTION I may be published in the County's SBE and Outreach Directory which may be shared with County Departments,contractors,consultants,and others in both electronic (internet,in ranet,a-mail,facsimile)and paper formats,unless exceptions are noted below. I agree to publication of all SECTION l information. ❑ l do not agree to publication ofthe following(check all that apply): ❑ Street Address ❑ Phone Number ❑ E-mail Address ❑ Mailing Address ❑ Fax Number ❑ Business Entity Status ECTION Certification of Ownership The undersigned is authorized to execute this Self Certification form on behalf of -PpW pm&A irk ez e kA Offn l2A CSW Irle— Name of Firm I 1501 VIk1 nq 5t. , S+e Zoo AlAtned0. G4 9Y501 XeK bildbeel,17Gti►7.yR-whold5al lord lurk Street Address(City,State,Zip Code) Name(s)of Owner(s) And swears under penalty of perjury that our firm meets the definition of MBE,WBE,DBE,SBE,LBE,DVBE,and/or OBE set forth on ' page 3 of this form and that all information contained in this form is true and correct.Any material misrepresentation will be grounds for terminating any purchase orders or contracts which may be or have been awarded. Signed in O'flAt►t1Ct<1f1 AlAVyll<" r (City,County,State) on Jm u a gj 25 1200 By MQJAmotyk 'Po%Q-c+AAmlvtlstgAtu! 1 (Print Name) (510) 33-4- 3A�0 0 iSi natureArea Code Phone No. Return this Self-Certification Form to the department who sent you this form or: Contra Costa County Affirmative Action Office 651 Pine Street—le Floor Martinez,CA 94553 ***********For Department Use ECT10N Departmental Concurrence The undersigned department concurs in the above Self-Certification form and is satisfied that the applicant meets the requirements for self certification as an MBE,WBE,DBE,SBE,LBE,DVBE,and/or OBE_ By (Print Name) (Department) (Signature of Department Head or Deputy) (Area Code) Phone No. Date Revised 09/10/04 a:SBEOutreachSelfCertification See Other Side Page 2 of 3 �� .. � � �_ � � �. ,. .� '.�: ''x° _ j� - - . . . � -. �, � _. _.. ._ ._. . ..� ._ _ �. f. , F. , -. .. �{ � � � F _ } '• l .. �' i ..,^' . .. 'M1Y�. J�§n• 25 07 03: 57p p. 5 Note: This form should be forwarded to the Affirmative Action Office within 10 days of its compietion. MBE, WBE, OBE, DBE, SBE, LBE, and DVBE Definitions: A Minority Business Enterprise(MBE)is a business entity which is at least 51%owned and whose management and daily business operations are controlled by one or more minorities who are citizens or lawful permanent residents of the United States and a member of a recognized ethnic or racial group. The management operations,and control must be substantial, real, and on-going on a regular basis. A Women Business Enterprise(WBE)is a business entity at least 51%owned and whose management and daily business operations are controlled by one or more women who are citizens or lawful permanent residents of the United States. The management operations,and control must be real, substantial and on-going,on a regular basis. A Other Business Enterprise(OBE)is any business which does not otherwise qualify as a Minority or Women Business Enterprise. A Disadvantaged Business Enterprise(DBE)is a small business concern(pursuant to Section 3 of the Small Business Act) owned and controlled by socially and economically disadvantaged individuals. This means that socially and economically disadvantaged individuals must own at least 51%of the business, and they must control the management and operations of the business. OBE criteria is used only for state or federally funded projects that require DBE goals. A Small Business Enterprise(SBE)is an independently owned and operated business;which is not dominant in its field of operation; the principal office of which is located in California;the officers of which are domiciled in California;and which, together with affiliates, has 100 or fewer employees and average annual gross receipts of ten million dollars($10,000,000)or less over the previous three years,or is a manufacturer with 100 or fewer employees. A Local Business Enterprise(LBE)is a business entity whose principal place of business is located within the boundaries of Contra Costa County. A Disabled Veteran Business Enterprise(DVBE)is a business concern certified by the administering agency as meeting all of the following: 1)a veteran of the military,naval, or air service of the United States with a serviciE•-r_onrtcc(ed disability of&t least 10 percent;and who is also a resident of California,2)one or more disabled veterar►s own 51%pere-e)ni of the firm,3)the management and control of the daily business operations are by one or more disabled veterans,and 4)it is a sole proprietorship corporation or partnership with its home office loo-ated in the United State::unci is riot c svbsidiaV of a foreign firm. Revised 09/10104 a:SBEOutreachSelfCertification See Other Side Page 3 of 3 ' � � .. .• �',.tip?',' '`"! ma ass j' t , I'.. To W-1 r i F°t Contra Costa County Solicitation Form Small Business Enterprise and Outreach Programs The Small Business Enterprise(SBE)Program applies to: (1) county-funded construction contracts of$25,000 or less;(2)purchasing transactions of $50,000 or less and(3)professional/personal service contracts of$50,000 or less. Note: Certain contracts and purchasing transactions are exempt (see SBE Program,pages 3-4,for list of exemptions). A Small Business Enterprise(SBE)is an independently owned and operated business;which is not dominant in its field of operation;the principal office of which is located in California;the officers of which are domiciled in California;and which,together with affiliates,has 100 or fewer employees and average annual gross receipts of ten million dollars($10,000,000)or less over the previous three years,or is a manufacturer with 100 or fewer employees. A Minority Business Enterprise(MBE)is a business entity which is at least 51°x6 owned and whose management and daily business operations are controlled by one or more minorities who are citizens or lawful permanent residents of the United States and a member of a recognized ethnic or racial group. The management operations,and control must be substantial,real,and on-going on a regular basis. A Women Business Enterprise(WBE)is a business entity at least 51%owned and whose management and daily business operations are controlled by one or more women who are citizens or lawful permanent residents of the United States. The management operations,and control must be real, substantial and on-going,on a regular basis. A Disadvantaged Business Enterprise(DBE)is a small business concern(pursuant to Section 3 of the Small Business Act)owned and controlled by socially and economically disadvantaged individuals. This means that socially and economically disadvantaged individuals must own at least 51%of the business,and they must control the management and operations of the business. DBE criteria is used only for state or federally funded projects that require DBE goals. A Local.Business Enterprise(LBE)is a business entity whose principal place of business is located within the boundaries of Contra Costa County. An Other Business Enterprise(OBE)is a business entity which does not otherwise qualify as an MBE or WBE. A Disabled Veteran Business Enterprise(DVBE)is a business entity at least 51%owned by one or more disabled veterans and whose daily business operations must be managed and controlled by one or more disabled veteran(s);the disabled veteran(s)who manages and controls the business is not required to be the disabled veteran business owner(s);and the home office must be located in the U.S.(the home office cannot be a branch or subsidiary of a foreign corporation,foreign firm,or other foreign based-business). The disabled Veteran must be a California resident have a service- connected disability of at least 10%or more and be an honorably discharged veteran of the U.S.Military,Naval or Air Services. ECTION 1 Firms Solicited (Use additional paper if needed) 1. Complete the following:, a. To your knowledge was any of your solicitation to an: MBE WBE DBE SB . LB'& OBE DVBE ❑ ❑ ❑ ❑ ❑ ❑ b. If yes, list the names of firm solicited i Use additional aper if needed . Telephone Check Appropriate Boxes Date Firm Name Contact Person Number MBE WBE DBE SBE LBE OBE DVBE 916-/Z Response/ CSL- Y f a / Doe q*1 I Bann a o /SF ❑ ❑ ❑ ❑ ❑ Res onset i 12 S 3) ❑ ❑ ❑ ❑ ❑ ❑ ❑ Response: 4) ❑ ❑ ❑ ❑ ❑ ❑ ❑ Response: Contra Costa County 1 of 2 - ;� . i _. __ _ {�. .. - j }. i:[�� i ' ' e �- .. _ r..n a � .. �..i, .�•, .. _ .....F.�J^nw.N, .. J .�., ._...) ,. a-.. a .�+ .. .. .. .. � .. .... � ........ ti � � � _...�. ' .. ` _ ... . v.i... _.. ..... _..__._ .. ... _ J ... , .. .. � r. ' ., 1 i\�• Solicitation Form Small Business Enterprise and Outreach Programs Firms Solicited Continued 5) ❑ ❑ ❑ ❑ ❑ ❑ ❑ Response: 6) FL3 ❑ ❑ ❑ ❑ ❑ ❑ Response: 7) ❑ ❑ ❑ ❑ ❑ ❑ ❑ Response: 8} ❑ ❑ ❑ ❑ ❑ ❑ ❑ Response: 9) Response: 70) ❑ ❑ ❑ ❑ ❑ ❑ ❑ Response: ECT10N Contract Awarded To: Name of Contract/Transaction--5`/e,,e%e e Q,("'-A�? Co ct/Transaction No.: Purchasing ProfessionaUPersonal Services Construction Fi arded Co ct/Tfansaction(Print) Date�07 trac saction Awarded 0/0en al/), P/l� L.7C • n 6 Stiept Address SSC''ity tate) (Zip Code) ConV�c Person Dol r ount of Coi itMrtrrransaction J�Pr� 1/neer' �5'a' D • DO (Ar a Code) Phone No. (Area Code) Fax No . e-mail 3/D 33 - .a 9 � io a3Z-,7Z6 Sco a of work or p rpo F 4 Department Head or Deputy ate ho o e-mail Department Note: For Department use only. 2 of 2 1