Loading...
Pre-Qualification - Kinney Construction - 2016-07-01 A/elert _ sANIT,i I : Costa Mesa Sanitary District ,,, �ORPORATE9` . . ..an Independent Special District REQUEST FOR PRE-QUALIFICATION OF BIDDERS COMMENCING WITH FORTHCOMING PUBLIC WORK BID Tenant Improvements for 290 Paularino Avenue Notice is hereby given that Costa Mesa Sanitary District(CMSD) has determined that all bidders on the tenant improvements for the new headquarters at 290 Paularino Avenue to be undertaken by the CMSD must be pre-qualified prior to submitting a bid on that project. It is mandatory that all Contractors who intend to submit a bid, fully complete the pre-qualification questionnaire, provide all materials requested herein, and be approved by CMSD to be on the final qualified Bidders list. No bid will be accepted from a Contractor that has failed to comply with these requirements. If two or more business entities submit a bid as part of a Joint Venture, or expect to submit a bid as part of a Joint Venture, each entity within the Joint Venture must be separately qualified to bid. The last date to submit a fully completed questionnaire is Friday,July 1, 2016. . Contractors are encouraged to submit pre-qualification packages as soon as possible, so that they may be notified of omissions of information to be remedied or of their pre-qualification status well in advance of the bid advertisement for this project. Project description is below: II Location: 290 Paularino, Costa Mesa, CA Size: 11,600 square feet Project Scope: The Costa Mesa Sanitary District purchased this building for their new headquarters. The construction improvement scope includes: Remodeling the lobby, various private offices, meeting rooms, break room, upgrading the restrooms for ADA compliance and adding a large town hall meeting room. The exterior will require minor building repairs and re-slurry and paint the parking lot. The facility will have new flooring and paint throughout. Answers to questions contained in the attached questionnaire, information about current bonding capacity, notarized statement from surety, and the most recent reviewed or audited financial statements, with accompanying notes and supplemental information, are required. CMSD use these documents as the basis of rating Contractors in respect to the size and scope of contracts upon which each Contractor is qualified to bid. CMSD reserves the right to check other sources available. CMSD's decision will be based on objective evaluation criteria. Pre-qualifying bid interviews will be conducted where the Contractor's assigned superintendent to this project will take part of the interview process. CMSD reserves the right to adjust, increase, limit, suspend or rescind the pre-qualification rating based on subsequently learned information. Contractors whose rating changes sufficient to disqualify them will be notified,and given an opportunity for a hearing consistent with the hearing procedures described below for appealing a pre-qualification rating. Protecting our community's health and the environment by providing solid waste and sewer collection services. Kg). www.cmsdca.gov Costa Mesa Sanitary District Page 2 of 3 While it is the intent of the pre-qualification questionnaire and documents required therewith to assist CMSD in determining bidder responsibility prior to bid and to aid CMSD in selecting the lowest responsible bidder, neither the fact of pre-qualification, nor any pre-qualification rating, will preclude CMSD from a post-bid consideration and determination of whether a bidder has the quality, fitness, capacity and experience to satisfactorily perform the proposed work, and has demonstrated the requisite trustworthiness. The pre-qualification packages should be submitted under seal and marked "CONFIDENTIAL" to Trendzitions, 25691 Atlantic Ocean, Suite B13, Lake Forest, California 92630. Questions can be directed to Mary Bradley at 949-727-9100 or at mbradley(u trendzitions.com. The pre-qualification packages (questionnaire answers and financial statements) submitted by Contractors are not public records and are not open to public inspection. All information provided will be kept confidential to the extent permitted by law. However, the contents may be disclosed to third parties for purpose of verification, or investigation of substantial allegations, or in the appeal hearing. State law requires that the names of contractors applying for pre-qualification status shall be public records subject to disclosure, and the first page of the questionnaire will be used for that purpose. Each questionnaire must be signed under penalty of perjury in the manner designated at the end of the form, by an individual who has the legal authority to bind the Contractor on whose behalf that person is signing. If any information provided by a Contractor becomes inaccurate,the Contractor must immediately notify CMSD and provide updated accurate information in writing, under penalty of perjury. CMSD reserves the right to waive minor irregularities and omissions in the information contained in the pre-qualification application submitted, to make all final determinations, and to determine at any time that the pre-qualification procedures will not be applied to a specific future public construction project. Contractors may submit pre-qualification packages to the offices of Trendzitions during regular business hours (Monday through Friday from 8:00 am to 5:00 pm). Contractors who submit a complete pre-qualification package will be notified of their qualification status no later than ten business days after submission of the information. CMSD may refuse to grant pre-qualification where the requested information and materials are not provided, or not provided by Friday, July 1, 2016. There is no appeal from a refusal for an incomplete or late application, but re-application for a later project is permitted. The closing time for bids will not be changed in order to accommodate supplementation of incomplete submissions, or late submissions. Where a timely and completed application results in a rating below that necessary to pre-qualify, an appeal can be made. An appeal is begun by the Contractor delivering notice to CMSD of its appeal of the decision with respect to its pre-qualification rating, no later than ten business days prior to the closing time for the receipt of bids for this public construction project. Without a timely appeal,the Contractor waives any and all rights to challenge the decision of CMSD,whether by administrative process,judicial process or any other legal process or proceeding. Costa Mesa Sanitary District Page 3 of 3 If the Contractor gives the required notice of appeal and requests a hearing, the hearing shall be conducted so that it is concluded no later than five business days after CMSD's receipt of the notice of appeal, and no later than five business days prior to the last date for the receipt of bids on the project. The hearing shall be an informal process conducted by a panel to whom the Board of Directors of the Costa Mesa Sanitary District has delegated responsibility to hear such appeals (the "Appeals Panel"). At or prior to the hearing, the Contractor will be advised of the basis for Costa Mesa Sanitary District's pre-qualification determination. The Contractor will be given the opportunity to present information and present reasons in opposition to the rating. Within one day after the conclusion of the hearing, the Appeals Panel will render its decision. It is the intention of Costa Mesa Sanitary District that the date for the submission and opening of bids will not be delayed or postponed to allow for completion of an appeal process. Note: A contractor may be found not pre-qualified for bidding on a specific public construction contract to be let by Costa Mesa Sanitary District, or on all contracts to be let by CMSD until the contractor meets CMSD's requirements. In addition, a contractor may be found not pre-qualified for either: (1) Omission of requested information or (2) Falsification of information NOTICE: To contractors who are using subcontractors for this job, please be advised that the Costa Mesa Sanitary District will require, as to subcontractors, one of the following: ❑ The qualification of subcontractors in the following crafts or trades, following acceptance of your bid, but before the award is made: ❑ Pre-qualification of all subcontractors. 11 Pre-qualification of subcontractors in certain crafts. Post-bid qualification review. COSTA MESA SANITARY DISTRICT PRE-QUALIFICATION QUESTIONNAIRE TENANT IMPROVEMENTS FOR 290 PAULARINO AVENUE ADAPTED WITH MINOR MODIFICATIONS FROM THE MODEL FORMS CREATED BY THE DEPARTMENT OF INDUSTRIAL RELATIONS Due Date: Friday, July 1, 2016 1 1 CONTACT INFORMATION James H Kinney Inc DBA Firm Name: Kinney Construction Check One: El Corporation (as it appears on license) ❑ Partnership ❑ Sole Prop. Contact Person: Jim Kinney Address: 830 W Fletcher Ave Orange,CA 92865 Phone: 714-279-8091/ 714-904-7255 cell Fax: 714-279-8092 If firm is a sole proprietor or partnership: Owner(s)of Company Contractor's License Number(s): 8401237 PART I. ESSENTIAL REQUIREMENTS FOR QUALIFICATION Contractor will be immediately disqualified if the answer to any of questions 1 through 5 is"no."r Contractor will be immediately disqualified if the answer to any of questions 6,7,8 or 9 is"yes."2 If the answer to question 8 is"yes,"and if debarment would be the sole reason for denial of pre-qualification, any pre-qualification issued will exclude the debarment period. 1. Contractor possesses a valid and current California Contractor's license for the project or projects for which it intends to submit a bid. EJ Yes ❑ No 2. Contractor has a liability insurance policy with a policy limit of at least $1,000,000 per occurrence and$3,000,000 aggregate. x❑ Yes Q No 3. Contractor has current workers'compensation insurance policy as required by the Labor Code or is legally self-insured pursuant to Labor Code section 3700 et. seq. ❑x Yes ❑ No❑ Contractor is exempt from this requirement, because it has no employees ,4-- - --Have -you- ttaehed--yettr- latest 33 o . - .- -3 5 . . a _, _ •-_..-.. .. ..- . • 3 Yes 111 NO NOTE: A financial statement that is not either reviewed or audited is not acceptable. A letter verifying availability of a line of credit may also be attached; however,it will be considered as supplemental information only, and is not a substitute for the required financial statement. 5. Have you attached a notarized statement from an admitted surety insurer (approved by the California Department of Insurance) and authorized to issue bonds in the State of California, which states: (a)that your current bonding capacity is sufficient for the project for which you ' A"no"answer to Question 4 will not be disqualifying if the contractor is exempt from complying with Question 4,for reasons explained in footnote 7. A contractor disqualified solely because of a"Yes"answer given to question 6.7,or 9 may appeal the disqualification and provide an explanation of the relevant circumstances during the appeal procedure. Public Contract Code section 20101(e)exempts from this requirement a contractor who has qualified as a small business pursuant to Government Code section I4837(d)(l),if the bid is"no more than 25 per cent of the qualifying amount provided in section 14837(d)(1)." As of January 1,2001.the qualifying amount is$10 million, and 25 per cent of that amount,therefore,is$2.5 million. 3 seek pre-qualification if you are seeking pre-qualification for a single project; or(if you are seeking pre-qualification valid for a year) (b)your current available bonding capacity?4 0 Yes ❑ No NOTE: Notarized statement must be from the surety company,not an agent or broker. 6. Has your contractor's license been revoked at any time in the last five years? If yes please explain. ❑ Yes © No 7. Has a surety firm completed a contract on your behalf, or paid for completion because your firm was default terminated by the project owner within the last five(5)years? ❑ Yes [ No 8. At the time of submitting this pre-qualification form, is your firm ineligible to bid on or be awarded a public construction contract,or perform as a subcontractor on a public construction contract, pursuant to either Labor Code section 1777.1 or Labor Code section 1777.7? ❑ Yes ® No If the answer is"Yes,"state the beginning and ending dates of the period of debarment: 9. At any time during the last five years, has your firm, or any of its owners or officers been convicted of a crime involving the awarding of a contract of a government construction project, or the bidding or performance of a government contract? ❑ Yes ® No Note: All selected subcontractors must meet these same requirements An additional notarized statement from the surety may be requested by CMSD at the time of submission of a bid,if this pre-qualification package is submitted more than 60 days prior to submission of the bid. 4 PART H. ORGANIZATION, HISTORY,ORGANIZATIONAL PERFORMANCE,COMPLIANCE WITH CIVIL AND CRIMINAL LAWS A. Current Organization and Structure of the Business For Firms That Are Corporations: I a. Date incorporated : 1980 1 b. Under the laws of what state: CA 1 c. Provide all the following information for each person who is either (a) an officer of the corporation(president,vice president, secretary,treasurer),or(b)the owner of at least ten per cent of the corporation's stock. Name Position Years with Co. %Ownership Social Security# James H Kinney President 36 60 519-56-4483 Sharon B Kinney Secretary 36 40 566-70-6859 1 d. Identify every construction firm that any person listed above has been associated with (as owner,general partner, limited partner or officer) at any time during the last five years. NOTE: For this question,"owner" and "partner" refer to ownership of ten per cent or more of the business,or 10 per cent or more of its stock,if the business is a corporation. Dates of Person's Participation Person's Name Construction Firm with Firm For Firms That Are Partnerships: 1 a. Date of formation: lb. Under the laws of what state: I c. Provide all the following information for each partner who owns 10 per cent or more of the firm. Name Position Years with Co. %Ownership Social Security# Id. Identify every construction company that any partner has been associated with (as owner, general partner, limited partner or officer)at any time during the last five years. 5 NOTE: For this question,"owner"and "partner" refer to ownership of ten per cent or more of the business,or ten per cent or more of its stock,if the business is a corporation. Dates of Person's Participation Person's Name Construction Company with Company For Firms That Are Sole Proprietorships: I a. Date of commencement of business. lb. Social security number of company owner. lc. Identify every construction firm that the business owner has been associated with(as owner, general partner, limited partner or officer) at any time during the last five years. NOTE: For this question,"owner" and "partner" refer to ownership of ten per cent or more of the business,or ten per cent or more of its stock,if the business is a corporation. Dates of Person's Participation Person's Name Construction Company with Company For Firms That Intend to Make a Bid as Part of a Joint Venture: I a. Date of commencement of joint venture. 1 b. Provide all of the following information for each finn that is a member of the joint venture that expects to bid on one or more projects: Name of firm %Ownership of Joint Venture B. History of the Business and Organizational Performance 2. Has there been any change in ownership of the firm at any time during the last three years? NOTE: A corporation whose shares are publicly traded is not required to answer this question. ❑ Yes ❑x No If"yes," explain on a separate signed page. 6 3. Is the firm a subsidiary, parent, holding company or affiliate of another construction firm? NOTE: Include information about other firms if one firm owns 50 per cent or more of another, or if an owner, partner, or officer of your firm holds a similar position in another firm. ❑ Yes ® No If"yes,"explain on a separate signed page. 4. Are any corporate officers,partners or owners connected to any other construction firms. NOTE: Include information about other firms if an owner, partner, or officer of your firm holds a similar position in another firm. ❑ Yes ® No If"yes,"explain on a separate signed page. 5. State your firm's gross revenues for each of the last three years: 2015 2014 2013 12,413,000 14 634 165 4.606.470 6. How many years has your organization been in business in California as a contractor or sub- contractor under your present business name and license number? 36 years 7. Is your firm currently the debtor in a bankruptcy case? ❑ Yes x❑ No If"yes," please attach a copy of the bankruptcy petition, showing the case number, and the date on which the petition was filed. 8. Was your firm in bankruptcy at any time during the last five years? (This question refers only to a bankruptcy action that was not described in answer to question 7, above) ❑ Yes x❑ No If"yes," please attach a copy of the bankruptcy petition, showing the case number and the date on which the petition was filed, and a copy of the Bankruptcy Court's discharge order, or of any other document that ended the case, if no discharge order was issued. Licenses 9. List all California construction license numbers, classifications and expiration dates of the California contractor licenses held by your firm: B-401237 EXP 02/28/2017 10. If any of your firm's license(s)are held in the name of a corporation or partnership, list below the names of the qualifying individual(s) listed on the CSLB records who meet(s) the experience and examination requirements for each license. James 1-1 Kinney 7 1 1. Has your firm changed names or license number in the past five years? ❑ Yes x❑ No If"yes,"explain on a separate signed page, including the reason for the change. 12. Has any owner, partner or(for corporations:) officer of your firm operated a construction firm under any other name in the last five years? n Yes Q No If"yes,"explain on a separate signed page, including the reason for the change, 13. Has any CSLB license held by your firm or its Responsible Managing Employee (RME) or Responsible Managing Officer(RMO)been suspended within the last five years? 111 Yes ENo If"yes,"please explain on a separate signed sheet. Disputes 14. At any time in the last five years has your firm been assessed and paid liquidated damages after completion of a project under a construction contract with either a public or private owner? ❑ YesE No If yes. explain on a separate signed page, identifying all such projects by owner, owner's address,the date of completion of the project,amount of liquidated damages assessed and all other information necessary to fully explain the assessment of liquidated damages. In the last fiveyears hasyour firm, or an • firm with which anyof your company's owners, 15. y been debarred, disqualified, removed or otherwise was associated, , officers or partners q prevented from bidding on, or completing, any government agency or public construction project for any reason? NOTE: "Associated with" refers to another construction firm in which an owner, partner or officer of your firm held a similar position,and which is listed in response to question lc or ldon this form. ElYes ® No If Pes "yes," explain on a separatesignedpage.a e. State whether the firm involved was the firm applying for pre-qualification here or another firm. Identify by name of the company, the name of the person within your firm who was associated with that company, the year of the event, the owner of the project,the project and the basis for the action. 16. In the last five years has your firm been denied an award of a public construction contract based on a finding by a public agency that your company was not a responsible bidder? ❑ Yes © No If signed"yes," P explain on a separate spage.a e. Identify the year of the event, the owner, the project and the basis for the finding by the public agency. * * * * * 8 NOTE: The following two questions refer only to disputes between your firm and the owner of a project.You need not include information about disputes between your firm and a supplier,another contractor,or subcontractor. You need not include information about"pass-through" disputes in which the actual dispute is between a sub-contractor and a project owner. (deleted Also, you may omit reference to all disputes about amounts less than $50,00) 17. In the past five years has any claim against your firm concerning your firm's work on a construction project been filed in court or arbitration? ❑ Yes n No If"yes," on separate signed sheets of paper identify the claim(s) by providing the project name,date of the claim,name of the claimant, a brief description of the nature of the claim, the court in which the case was tiled and a brief description of the status of the claim (pending or, if resolved, a brief description of the resolution). 18. In the past five years has your firm made any claim against a project owner concerning work on a project or payment for a contract and filed that claim in court or arbitration? ❑ Yes x❑ No If"yes," on separate signed sheets of paper identify the claim by providing the project name, date of the claim, name of the entity(or entities) against whom the claim was filed, a brief description of the nature of the claim, the court in which the case was filed and a brief description of the status of the claim (pending, or if resolved, a brief description of the resolution). * * * * * 19. At any time during the past five years, has any surety company made any payments on your firm's behalf as a result of a default,to satisfy any claims made against a performance or payment bond issued on your firm's behalf, in connection with a construction project, either public or private? ❑ Yes x❑ No If"yes," explain on a separate signed page the amount of each such claim, the name and telephone number of the claimant, the date of the claim, the grounds for the claim, the present status of the claim, the date of resolution of such claim if resolved, the method by which such was resolved if resolved, the nature of the resolution and the amount, if any, at which the claim was resolved. 20. In the last five years has any insurance carrier, for any form of insurance, refused to renew the insurance policy for your firm? ❑ Yes ❑x No If"yes,"explain on a separate signed page. Name the insurance carrier, the form of insurance and the year of the refusal. 9 Criminal Matters and Related Civil Suits 21. Has your firm or any of its owners,officers or partners ever been found liable in a civil suit or found guilty in a criminal action for making any false claim or material misrepresentation to any public agency or entity? ❑ Yes x❑ No If"yes," explain on a separate signed page, including identifying who was involved, the name of the public agency, the date of the investigation and the grounds for the finding. 22. Has your firm or any of its owners, officers or partners ever been convicted of a crime involving any federal, state, or local law related to construction? ❑ Yes x❑ No If"yes,"explain on a separate signed page,including identifying who was involved,the name of the public agency,the date of the conviction and the grounds for the conviction. 23. Has your firm or any of its owners, officers or partners ever been convicted of a federal or state crime of fraud, theft, or any other act of dishonesty? ❑ Yes ❑x No If"yes," identify on a separate signed page the person or persons convicted, the court (the county if a state court, the district or location of the federal court), the year and the criminal conduct. Bonding ..4. Bonding capacity: Provide documentation from your surety identifying the following: Name of bonding company/surety: *see attached Name of surety agent, address and telephone number: 25. If your firm was required to pay a premium of more than one per cent for a performance and payment bond on any project(s)on which your firm worked at any time during the last three years, state the percentage that your firm was required to pay. You may provide an explanation for a percentage rate higher than one per cent, if you wish to do so. 26. List all other sureties(name and full address)that have written bonds for your firm during the last five years, including the dates during which each wrote the bonds: 10 27. During the last five years,has your firm ever been denied bond coverage by a surety company, or has there ever been a period of time when your firm had no surety bond in place during a public or private construction project when one was required? n Yes ❑x No If yes, provide details on a separate signed sheet indicating the date when your firm was denied coverage and the name of the company or companies which denied coverage; and the period during which you had no surety bond in place. C. Compliance with Occupational Safety and Health Laws and with Other Labor Legislation Safety 28. Has CAL OSHA cited and assessed penalties against your firm for any"serious,""willful" or`repeat"violations of its safety or health regulations in the past five years? NOTE: If you have filed an appeal of a citation,and the Occupational Safety and Health Appeals Board has not yet ruled on your appeal,you need not include information about it. ❑ Yes n No If"yes," attached a separate signed page describing the citations, including information about the dates of the citations, the nature of the violation, the project on which the citation(s) was or were issued, the amount of penalty paid, if any. If the citation was appealed to the Occupational Safety and Health Appeals Board and a decision has been issued, state the case number and the date of the decision. 29. Has the federal Occupational Safety and Health Administration cited and assessed penalties against your firm in the past five years? NOTE: If you have filed an appeal of a citation and the Appeals Board has not yet ruled on your appeal, or if there is a court appeal pending, you need not include information about the citation. TI Yes ❑x No If"yes," attach a separate signed page describing each citation. 30. Has the EPA or any Air Quality Management District or any Regional Water Quality Control Board cited and assessed penalties against either your firm or the owner of a project on which your firm was the prime or subcontractor, in the past five years? NOTE: If you have filed an appeal of a citation and the Appeals Board has not yet ruled on your appeal, or if there is a court appeal pending,you need not include information about the citation. El Yes ❑x No II If"yes," attach a separate signed page describing each citation. 31. How often do you require documented safety meetings to be held for construction employees and field supervisors during the course of a project? Minimum weekly,special circumstances may require daily 32. List your firm's Experience Modification Rate (EMR) (California workers' compensation insurance) for each of the past three premium years: NOTE: An Experience Modification Rate is issued to your firm annually by your workers' compensation insurance carrier. Current year: Previous year: Year prior to previous year: If your EMR for any of these three years is or was 1.00 or higher you may, if you wish, attach a letter of explanation. 33. Within the last five years has there ever been a period when your firm had employees but was without workers' compensation insurance or state-approved self-insurance? ❑ Yes x❑ No If"yes," please explain the reason for the absence of workers' compensation insurance on a separate signed page. If '`No," please- provide a statement by your current workers' compensation insurance carrier that verifies periods of workers' compensation insurance coverage for the last five years. (If your firm has been in the construction business for less than five years, provide a statement by your workers' compensation insurance carrier verifying continuous workers' compensation insurance coverage for the period that your firm has been in the construction business.) Prevailing Wage and Apprenticeship Compliance Record 34. Has there been more than one occasion during the last five years in which your firm was required to pay either back wages or penalties for your own firm's failure to comply with the state's prevailing wage laws? NOTE: This question refers only to your own firm's violation of prevailing wage laws, not to violations of the prevailing wage laws by a subcontractor. El Yes 0 No If "yes," attach a separate signed page or pages, describing the nature of each violation, identifying the name of the project, the date of its completion, the public agency for which it was constructed; the number of employees who were initially underpaid and the amount of back wages and penalties that you were required to pay. 12 35. During the last five years,has there been more than one occasion in which your own firm has been penalized or required to pay back wages for failure to comply with the federal Davis- Bacon prevailing wage requirements? ❑ Yes 0 No "see attached" If "yes," attach a separate signed page or pages describing the nature of the violation, identifying the name of the project, the date of its completion, the public agency for which it was constructed; the number of employees who were initially underpaid, the amount of back wages you were required to pay along with the amount of any penalty paid. 36. Provide the name, address and telephone number of the apprenticeship program (approved by the California Apprenticeship Council) from whom you intend to request the dispatch of apprentices to your company for use on any public work project for which you are awarded a contract by Costa Mesa Sanitary District. 37. If your firm operates its own State-approved apprenticeship program: (a) Identify the craft or crafts in which your firm provided apprenticeship training in the past year. (b) State the year in which each such apprenticeship program was approved,and attach evidence of the most recent California Apprenticeship Council approval(s) of your apprenticeship program(s). (c) State the number of individuals who were employed by your firm as apprentices at any time during the past three years in each apprenticeship and the number of persons who, during the past three years, completed apprenticeships in each craft while employed by your firm. 38. At any time during the last five years, has your firm been found to have violated any provision of California apprenticeship laws or regulations, or the laws pertaining to use of apprentices on public construction? NOTE: You may omit reference to any incident that occurred prior to January 1, 1998, if the violation was by a subcontractor and your firm, as general contractor on a project, had no knowledge of the subcontractor's violation at the time they occurred. 13 ❑ Yes n No If"yes," provide the date(s) of such findings, and attach copies of the Department's final decision(s). PART III. RECENT CONSTRUCTION PROJECTS COMPLETED 1. Contractor shall provide information about its six most recently completed projects of the same size and scope. Please identify if the project was public or private. Names and references must be current and verifiable. For each, list the number of change orders, the change in cost and the aggregate change in cost for the project. Use separate sheets of paper that contain all of the following information: Project Name: FXG Moses Lake Expansion 5178 Randolph Rd.NE, Moses Lake, WA 98837 Location: Owner: FedEx Ground Package Systems, Inc. Owner Contact (name and current phone number): Kevin Stanley 412/262-6270 Architect or Engineer: Womer&Associates Architect or Engineer Contact(name and current phone number): Womer&Associates 509'534-4884 Construction Manager(name and current phone number): N/A Description of Project, Scope of Work Performed: Warehouse Expansion,Administrative Office Expansion/Renovation &Site improvements Total Value of Construction (including change orders): Original tract=S 970,207.00 .1 _:.. .,588.50 Total ontract= S1,194,7'.. 0 14 Original Scheduled Completion Date: October 31,2014 Time Extensions Granted(number of days): 64 days due to change order work Actual Date of Completion: January 29,2015 I,the undersigned,certify and declare that I have read all the foregoing answers to this prequalification questionnaire and know their contents. The matters stated in the questionnaire answers are true of my own knowledge and belief, except as to those matters stated on information and belief, and as to those matters I believe them to be true. I declare under penalty of perjury under the laws of the State of California,that the foregoing is correct. Dated: (Name) 15 ❑ Yes ❑x No If"yes," provide the date(s) of such findings, and attach copies of the Department's final decision(s). PART III. RECENT CONSTRUCTION PROJECTS COMPLETED 1. Contractor shall provide information about its six most recently completed projects of the same size and scope. Please identify if the project'was public or private. Names and references must be current and verifiable. For each, list the number of change orders, the change in cost and the aggregate change in cost for the project. Use separate sheets of paper that contain all of the following information: Project Name: Fountain Building Location: 4816 Fountain Avenue, Los Angeles,CA 90027 Owner: Church of Scientology Owner Contact(name and current phone number): Jack Kruchko 323/632-0952 Architect or Engineer: Kamus &Keller Q3 Engineers, Inc. Architect or Engineer Contact(name and current phone number): Kamus&Keller - Gory Antila - 805/583-5935 Q3 Engineers - Robert Morales - 714/258-6901 Construction Manager(name and current phone number): Gensler - Gary Downer 310/583-5935 Description of Project, Scope of Work Performed: Conversion of a 4 story,90 unit 1950's apartment building into a modern hotel. Including modernization of elevator, electrical&mechanical systems. Total Value of Construction (including change orders): Original Contract= $3,825,850.00 CO's I through 30=$ 593,907.86 Total Contract= $4,419,757.86 14 Original Scheduled Completion Date: 10/31/14 Time Extensions Granted(number of days): 343 calendar days Actual Date of Completion: 10/09/15 I,the undersigned,certify and declare that I have read all the foregoing answers to this prequalification questionnaire and know their contents. The matters stated in the questionnaire answers are true of my own knowledge and belief, except as to those matters stated on information and belief, and as to those matters I believe them to be true. I declare under penalty of perjury under the laws of the State of California,that the foregoing is correct. Dated: (Name) 15 ❑ Yes x❑ No If"yes," provide the date(s) of such findings, and attach copies of the Department's final decision(s). PART III. RECENT CONSTRUCTION PROJECTS COMPLETED 1. Contractor shall provide information about its six most recently completed projects of the same size and scope. Please identify if the project was public or private. Names and references must be current and verifiable. For each, list the number of change orders, the change in cost and the aggregate change in cost for the project. Use separate sheets of paper that contain all of the following information: Project Name: Golden Crest Building Location: 1825 N. Bronson Avenue, Los Angeles, CA Owner: Church of Scientology Owner Contact (name and current phone number): Jack Kruchko 323/632-0952 Architect or Engineer: Kamus& Keller Q3 Engineering. Inc. Architect or Engineer Contact(name and current phone number): Kamus & Keller-Cory Antila - 805/583-5935 Q3 Engineers, Inc. - Robert Morales - 714/258-6901 Construction Manager(name and current phone number): Gensler- Gary Downer 310/583-5935 Description of Project, Scope of Work Performed: Conversion of a 3 story 65 unit 1950's apartment building into a modem hotel, including modernization of elevator. electrical & mechanical systems. Total Value of Construction(including change orders): Original Contract=$3,759,790.00 Change Orders= $ 749,840.42 Total Contract= $4,509,630.42 14 Original Scheduled Completion Date: 8/04/14 Time Extensions Granted(number of days): 432 calendar days Actual Date of Completion: 10/09/15 I,the undersigned,certify and declare that I have read all the foregoing answers to this prequalification questionnaire and know their contents. The matters stated in the questionnaire answers are true of my own knowledge and belief, except as to those matters stated on information and belief, and as to those matters I believe them to be true. I declare under penalty of perjury under the laws of the State of California,that the foregoing is correct. Dated: (Name) 15 ❑ Yes E] No If"yes," provide the date(s) of such findings, and attach copies of the Department's final decision(s). PART III. RECENT CONSTRUCTION PROJECTS COMPLETED 1. Contractor shall provide information about its six most recently completed projects of the same size and scope. Please identify if the project was public or private. Names and references must be current and verifiable. For each, list the number of change orders, the change in cost and the aggregate change in cost for the project. Use separate sheets of paper that contain all of the following information: Project Name: Bridge Publications Archival Manufacturing T.I. Location: 5600 East Olympic Blvd.,City of Commerce,CA 90022 Owner: Bridge Publications Owner Contact(name and current phone number): Jaime McClintock-email:jmc(a scientology.net 323/888-6200 Architect or Engineer: RGA Office of Architectural Design Architect or Engineer Contact(name and current phone number): Dennis Roy 949/341-0920 Construction Manager(name and current phone number): Gensler-Davor Dakic 213/327-3704 Description of Project, Scope of Work Performed: Construction of a recording and preservation line. Including all process piping, clean room construction,including air scrubbing,upgraded electrical& mechanical systems. Total Value of Construction(including change orders): Original Contract=$2,652,959.50 Change Orders =S I 36,787.36 Total Contract =52,789,746.86 14 Original Scheduled Completion Date: 11/05/14 Time Extensions Granted(number of days): 15 calendar days Actual Date of Completion: 11 20/14 I,the undersigned,certify and declare that I have read all the foregoing answers to this prequalification questionnaire and know their contents. The matters stated in the questionnaire answers are true of my own knowledge and belief, except as to those matters stated on information and belief, and as to those matters I believe them to be true. I declare under penalty of perjury under the laws of the State of California,that the foregoing is correct. Dated: (Name) 15 ❑ Yes x❑ No If"yes," provide the date(s) of such findings, and attach copies of the Department's final decision(s). PART III. RECENT CONSTRUCTION PROJECTS COMPLETED Contractor shall provide information about its six most recently completed projects of the same size and scope. Please identify if the project was public or private. Names and references must be current and verifiable. For each. list the number of change orders, the change in cost and the aggregate change in cost for the project. Use separate sheets of paper that contain all of the following information: Project Name: FedEx Anaheim CY14 Facility Expansion Location: 590 E. Orangethorpe Avenue, Anaheim, CA 92805 Owner: FedEx Ground Package System, Inc. Owner Contact(name and current phone number): Chas Ainsworth 412/859-2644 Architect or Engineer: Milburn Architecture, Inc. Architect or Engineer Contact(name and current phone number): John Milburn 9161622-3232 Construction Manager(name and current phone number): N/A Description of Project, Scope of Work Performed: General building renovation& indoor parking,security office, trailer parking and ADA parking modifications,site work-trialer parking, fences/gates,mechanical,electrical&plumbing systems asphalt pavement including aggregate base course,and concrete pavements. Total Value of Construction (including change orders): Original Contract=$ 879,500.00 Change Orders =S 202,442.00 Total Contract =$1,081,942.00 14 Original Scheduled Completion Date: 10/31/14 Time Extensions Granted(number of days): 396 calendar days Actual Date of Completion: 09/30/15 I,the undersigned,certify and declare that I have read all the foregoing answers to this prequalification questionnaire and know their contents. The matters stated in the questionnaire answers are true of my own knowledge and belief, except as to those matters stated on information and belief, and as to those matters I believe them to be true. I declare under penalty of perjury under the laws of the State of California,that the foregoing is correct. Dated: (Name) 15 El Yes x❑ No If"yes," provide the date(s) of such findings, and attach copies of the Department's final decision(s). PART III. RECENT CONSTRUCTION PROJECTS COMPLETED 1. Contractor shall provide information about its six most recently completed projects of the same size and scope. Please identify if the project was public or private. Names and references must be current and verifiable. For each, list the number of change orders, the change in cost and the aggregate change in cost for the project. Use separate sheets of paper that contain all of the following information: Project Name: FedEx Ground-Rialto(RLTO#923)CY15 Parking Expansion Location: 330 Resource Drive.Bloomington,CA 92316 Owner: FedEx Ground Package System, Inc. Owner Contact(name and current phone number): William D. Paoleschi,P.E. 412%262-6240 Architect or Engineer: RGA,Office of Architecture Design,Inc. Architect or Engineer Contact(name and current phone number): Dennis Roy 949/341-0920 Construction Manager(name and current phone number): N'A Description of Project, Scope of Work Performed: Parking Expansion: demolition,landscaping,site work, grading,asphalt paving, HC striping/signage, fencing,concrete,and electrical work. Total Value of Construction (including change orders): Original Contract=S620,300.00 Change Orders =S 72,125.14 Total Contract =S692,425.14 14 Original Scheduled Completion Date: 11'16'15 Time Extensions Granted(number of days): None Actual Date of Completion: 1 1 09/15 I,the undersigned,certify and declare that I have read all the foregoing answers to this prequalification questionnaire and know their contents. The matters stated in the questionnaire answers are true of my own knowledge and belief, except as to those matters stated on information and belief, and as to those matters I believe them to be true. I declare under penalty of perjury under the laws of the State of California,that the foregoing is correct. Dated: Please see the next page for signature. (Name) 15 Original Scheduled Completion Date: Time Extensions Granted(number of days): Actual Date of Completion: I,the undersigned,certify and declare that I have read all the foregoing answers to this prequalification questionnaire and know their contents. The matters stated in the questionnaire answers are true of my own knowledge and belief, except as to those matters stated on information and belief, and as to those matters I believe them to be true. I declare under penalty of perjury under the laws of the State of California,that the foregoing is correct. Dated: - 15 1 SSP aSANir Costa Mesa SanitaryDistrict *GRPORATE°` . . ..an Independent Special District REQUEST FOR PRE-QUALIFICATION OF BIDDERS COMMENCING WITH FORTHCOMING PUBLIC WORK BID Tenant Improvements for 290 Paularino Avenue Notice is hereby given that Costa Mesa Sanitary District (CMSD) has determined that all bidders on the tenant improvements for the new headquarters at 290 Paularino Avenue to be undertaken by the CMSD must be pre-qualified prior to submitting a bid on that project. It is mandatory that all Contractors who intend to submit a bid, fully complete the pre-qualification questionnaire, provide all materials requested herein, and be approved by CMSD to be on the final qualified Bidders list. No bid will be accepted from a Contractor that has failed to comply with these requirements. If two or more business entities submit a bid as part of a Joint Venture,or expect to submit a bid as part of a Joint Venture, each entity within the Joint Venture must be separately qualified to bid. The last date to submit a fully completed questionnaire is Friday, July 1, 2016. . Contractors are encouraged to submit pre-qualification packages as soon as possible, so that they may be notified of omissions of information to be remedied or of their pre-qualification status well in advance of the bid advertisement for this project. Project description is below: Location: 290 Paularino, Costa Mesa, CA Size: 11,600 square feet Project Scope: The Costa Mesa Sanitary District purchased this building for their new headquarters. The construction improvement scope includes: Remodeling the lobby, various private offices, meeting rooms, break room, upgrading the restrooms for ADA compliance and adding a large town hall meeting room. The exterior will require minor building repairs and re-slurry and paint the parking lot. The facility will have new flooring and paint throughout. Answers to questions contained in the attached questionnaire, information about current bonding capacity, notarized statement from surety, and the most recent reviewed or audited financial statements, with accompanying notes and supplemental information, are required. CMSD use these documents as the basis of rating Contractors in respect to the size and scope of contracts upon which each Contractor is qualified to bid. CMSD reserves the right to check other sources available. CMSD's decision will be based on objective evaluation criteria. Pre-qualifying bid interviews will be conducted where the Contractor's assigned superintendent to this project will take part of the interview process. CMSD reserves the right to adjust, increase, limit, suspend or rescind the pre-qualification rating based on subsequently learned information. Contractors whose rating changes sufficient to disqualify them will be notified,and given an opportunity for a hearing consistent with the hearing procedures described below for appealing a pre-qualification rating. Protecting our community's health and the environment by providing solid waste and sewer collection services. • www.crosdca.gov Costa Mesa Sanitary District Page 2 of 3 While it is the intent of the pre-qualification questionnaire and documents required therewith to assist CMSD in determining bidder responsibility prior to bid and to aid CMSD in selecting the lowest responsible bidder, neither the fact of pre-qualification, nor any pre-qualification rating, will preclude CMSD from a post-bid consideration and determination of whether a bidder has the quality, fitness, capacity and experience to satisfactorily perform the proposed work, and has demonstrated the requisite trustworthiness. The pre-qualification packages should be submitted under seal and marked "CONFIDENTIAL" to Trendzitions, 25691 Atlantic Ocean, Suite B13, Lake Forest, California 92630. Questions can be directed to Mary Bradley at 949-727-9100 or at mbradlev(iitrendzitions.com. The pre-qualification packages (questionnaire answers and financial statements) submitted by Contractors are not public records and are not open to public inspection. All information provided will be kept confidential to the extent permitted by law. However, the contents may be disclosed to third parties for purpose of verification, or investigation of substantial allegations, or in the appeal hearing. State law requires that the names of contractors applying for pre-qualification status shall be public records subject to disclosure, and the first page of the questionnaire will be used for that purpose. Each questionnaire must be signed under penalty of perjury in the manner designated at the end of the form, by an individual who has the legal authority to bind the Contractor on whose behalf that person is signing. If any information provided by a Contractor becomes inaccurate,the Contractor must immediately notify CMSD and provide updated accurate information in writing, under penalty of perjury. CMSD reserves the right to waive minor irregularities and omissions in the information contained in the pre-qualification application submitted, to make all final determinations, and to determine at any time that the pre-qualification procedures will not be applied to a specific future public construction project. Contractors may submit pre-qualification packages to the offices of Trendzitions during regular business hours (Monday through Friday from 8:00 am to 5:00 pm). Contractors who submit a complete pre-qualification package will be notified of their qualification status no later than ten business days after submission of the information. CMSD may refuse to grant pre-qualification where the requested information and materials are not provided, or not provided by Friday, July 1, 2016. There is no appeal from a refusal for an incomplete or late application,but re-application for a later project is permitted. The closing time for bids will not be changed in order to accommodate supplementation of incomplete submissions, or late submissions. Where a timely and completed application results in a rating below that necessary to pre-qualify, an appeal can be made. An appeal is begun by the Contractor delivering notice to CMSD of its appeal of the decision with respect to its pre-qualification rating, no later than ten business days prior to the closing time for the receipt of bids for this public construction project. Without a timely appeal,the Contractor waives any and all rights to challenge the decision of CMSD,whether by administrative process,judicial process or any other legal process or proceeding. Costa Mesa Sanitary District Page 3 of 3 If the Contractor gives the required notice of appeal and requests a hearing, the hearing shall be conducted so that it is concluded no later than five business days after CMSD's receipt of the notice of appeal, and no later than five business days prior to the last date for the receipt of bids on the project. The hearing shall be an informal process conducted by a panel to whom the Board of Directors of the Costa Mesa Sanitary District has delegated responsibility to hear such appeals (the "Appeals Panel"). At or prior to the hearing, the Contractor will be advised of the basis for Costa Mesa Sanitary District's pre-qualification determination. The Contractor will be given the opportunity to present information and present reasons in opposition to the rating. Within one day after the conclusion of the hearing, the Appeals Panel will render its decision. It is the intention of Costa Mesa Sanitary District that the date for the submission and opening of bids will not be delayed or postponed to allow for completion of an appeal process. Note: A contractor may be found not pre-qualified for bidding on a specific public construction contract to be let by Costa Mesa Sanitary District, or on all contracts to be let by CMSD until the contractor meets CMSD's requirements. In addition, a contractor may be found not pre-qualified for either: (1)Omission of requested information or (2) Falsification of information * * * * * NOTICE: To contractors who are using subcontractors for this job, please be advised that the Costa Mesa Sanitary District will require, as to subcontractors, one of the following: ❑ The qualification of subcontractors in the following crafts or trades, following acceptance of your bid, but before the award is made: n Pre-qualification of all subcontractors. ❑ Pre-qualification of subcontractors in certain crafts. • Post-bid qualification review. COSTA MESA SANITARY DISTRICT PRE-QUALIFICATION QUESTIONNAIRE TENANT IMPROVEMENTS FOR 290 PAULARINO AVENUE ADAPTED WITH MINOR MODIFICATIONS FROM THE MODEL FORMS CREATED BY THE DEPARTMENT OF INDUSTRIAL RELATIONS Due Date: Friday, July 1, 2016 1 CONTACT INFORMATION James H Kinney Inc DBA Firm Name: Kinney Construction Check One: E Corporation (as it appears on license) ❑ Partnership ❑ Sole Prop. Contact Person: Jim Kinney • Address: 830 W Fletcher Ave Orange,CA 92865 Phone: 714-279-8091/ 714-904-7255 cell Fax: 714-279-8092 If firm is a sole proprietor or partnership: Owner(s)of Company Contractor's License Number(s): 8401237 PART I. ESSENTIAL REQUIREMENTS FOR QUALIFICATION Contractor will be immediately disqualified if the answer to any of questions 1 through 5 is"no.' Contractor will be immediately disqualified if the answer to any of questions 6,7,8 or 9 is"yes."2 If the answer to question 8 is"yes,"and if debarment would be the sole reason for denial of pre-qualification, any pre-qualification issued will exclude the debarment period. 1. Contractor possesses a valid and current California Contractor's license for the project or projects for which it intends to submit a bid. ❑x Yes ❑ No 2. Contractor has a liability insurance policy with a policy limit of at least $1,000,000 per occurrence and$3,000,000 aggregate. n Yes n No 3. Contractor has current workers' compensation insurance policy as required by the Labor Code or is legally self-insured pursuant to Labor Code section 3700 et. seq. ❑x Yes ❑ No❑ Contractor is exempt from this requirement, because it has no employees 4. ---Haeme--yeu--attached -yeur- latest a a a . - • . e . . - le •. • -. ' ❑ Yes ❑ Nn NOTE: A financial statement that is not either reviewed or audited is not acceptable. A letter verifying availability of a line of credit may also be attached; however,it will be considered as supplemental information only, and is not a substitute for the required financial statement. 5. Have you attached a notarized statement from an admitted surety insurer (approved by the California Department of Insurance) and authorized to issue bonds in the State of California, which states: (a)that your current bonding capacity is sufficient for the project for which you A"no"answer to Question 4 will not be disqualifying if the contractor is exempt from complying with Question 4,for reasons explained in footnote 7. 2 A contractor disqualified solely because of a"Yes"answer given to question 6,7,or 9 may appeal the disqualification and provide an explanation of the relevant circumstances during the appeal procedure. Public Contract Code section 20101(e)exempts from this requirement a contractor who has qualified as a small business pursuant to Government Code section l 4837(d)(1),if the bid is"no more than 25 per cent of the qualifying amount provided in section 14837(d)(1)." As of January 1,2001.the qualifying amount is$10 million. and 25 per cent of that amount,therefore,is$2.5 million. 3 seek pre-qualification if you are seeking pre-qualification for a single project; or(if you are seeking pre-qualification valid for a year)(b)your current available bonding capacity? Q Yes ❑ No NOTE: Notarized statement must be from the surety company,not an agent or broker. 6. Has your contractor's license been revoked at any time in the last five years? If yes please explain. ❑ Yes E No 7. Has a surety firm completed a contract on your behalf, or paid for completion because your firm was default terminated by the project owner within the last five(5)years? ❑ Yes © No 8. At the time of submitting this pre-qualification form, is your firm ineligible to bid on or be awarded a public construction contract,or perform as a subcontractor on a public construction contract, pursuant to either Labor Code section 1777.1 or Labor Code section 1777.7? ❑ Yes ® No If the answer is"Yes," state the beginning and ending dates of the period of debarment: 9. At any time during the last five years, has your firm, or any of its owners or officers been convicted of a crime involving the awarding of a contract of a government construction project, or the bidding or performance of a government contract? ❑ Yes ® No Note: All selected subcontractors must meet these same requirements ' An additional notarized statement from the surety may be requested by CMSD at the time of submission of a bid,if this pre-qualification package is submitted more than 60 days prior to submission of the bid. 4 PART II. ORGANIZATION, HISTORY, ORGANIZATIONAL PERFORMANCE,COMPLIANCE WITH CIVIL AND CRIMINAL LAWS A. Current Organization and Structure of the Business For Firms That Are Corporations: la. Date incorporated : 1980 lb. Under the laws of what state: CA 1 c. Provide all the following information for each person who is either (a) an officer of the corporation(president,vice president, secretary,treasurer),or(b)the owner of at least ten per cent of the corporation's stock. Name Position Years with Co. %Ownership Social Security# James H Kinney President 36 60 519-56-4483 Sharon B Kinney Secretary 36 40 566-70-6859 Id. Identify every construction firm that any person listed above has been associated with (as owner, general partner, limited partner or officer)at any time during the last five years. NOTE: For this question,"owner" and "partner" refer to ownership of ten per cent or more of the business,or 10 per cent or more of its stock,if the business is a corporation. Dates of Person's Participation Person's Name Construction Firm with Firm For Firms That Are Partnerships: 1 a. Date of formation: lb. Under the laws of what state: 1 c. Provide all the following information for each partner who owns 10 per cent or more of the firm. Name Position Years with Co. %Ownership Social Security# Id. Identify every construction company that any partner has been associated with (as owner, general partner, limited partner or officer)at any time during the last five years. 5 NOTE: For this question,"owner" and"partner" refer to ownership of ten per cent or more of the business,or ten per cent or more of its stock,if the business is a corporation. Dates of Person's Participation Person's Name Construction Company with Company For Firms That Are Sole Proprietorships: 1 a. Date of commencement of business. lb. Social security number of company owner. 1 c. Identify every construction firm that the business owner has been associated with(as owner, general partner, limited partner or officer)at any time during the last five years. NOTE: For this question,"owner" and"partner" refer to ownership of ten per cent or more of the business,or ten per cent or more of its stock,if the business is a corporation. Dates of Person's Participation Person's Name Construction Company with Company For Firms That Intend to Make a Bid as Part of a Joint Venture: I a. Date of commencement of joint venture. lb. Provide all of the following information for each firm that is a member of the joint venture that expects to bid on one or more projects: Name of firm %Ownership of Joint Venture B. History of the Business and Organizational Performance 2. Has there been any change in ownership of the firm at any time during the last three years? NOTE: A corporation whose shares are publicly traded is not required to answer this question. Yes Ox No If"yes,"explain on a separate signed page. 6 3. Is the firm a subsidiary,parent,holding company or affiliate of another construction firm? NOTE: Include information about other firms if one firm owns 50 per cent or more of another, or if an owner, partner, or officer of your firm holds a similar position in another firm. ❑ Yes ® No If"yes,"explain on a separate signed page. 4. Are any corporate officers,partners or owners connected to any other construction firms. NOTE: Include information about other firms if an owner,partner, or officer of your firm holds a similar position in another firm. n Yes EI No If"yes," explain on a separate signed page. ,F< 5. State your firm's gross revenues for each of the last three years: 2015 2014 2013 12,413,000 14 634 165 4 606.70 • 6. How many years has your organization been in business in California as a contractor or sub- contractor under your present business name and license number? 36 years 7. Is your firm currently the debtor in a bankruptcy case? ❑ Yes 0 No If"yes," please attach a copy of the bankruptcy petition, showing the case number, and the date on which the petition was filed. 8. Was your firm in bankruptcy at any time during the last five years? (This question refers only to a bankruptcy action that was not described in answer to question 7, above) ❑ Yes x❑ No If"yes," please attach a copy of the bankruptcy petition, showing the case number and the date on which the petition was filed, and a copy of the Bankruptcy Court's discharge order, or of any other document that ended the case, if no discharge order was issued. Licenses 9. List all California construction license numbers, classifications and expiration dates of the California contractor licenses held by your firm: B-401237 EXP 02/28/2017 10. If any of your firm's license(s)are held in the name of a corporation or partnership, list below the names of the qualifying individual(s) listed on the CSLB records who meet(s) the experience and examination requirements for each license. James H Kinney 'rs 7 11. Has your firm changed names or license number in the past five years? ❑ Yes No If"yes," explain on a separate signed page, including the reason for the change. 12. Has any owner, partner or (for corporations:) officer of your firm operated a construction firm under any other name in the last five years? ❑ Yes ❑x No If"yes," explain on a separate signed page, including the reason for the change_ 13. Has any CSLB license held by your firm or its Responsible Managing Employee (RIME) or Responsible Managing Officer(RMO)been suspended within the last five years'? ❑ Yes E No If"yes,"please explain on a separate signed sheet. Disputes 14. At any time in the last five years has your firm been assessed and paid liquidated damages after completion of a project under a construction contract with either a public or private owner? Yes E No If yes. explain on a separate signed page, identifying all such projects by owner, owner's address, the date of completion of the project,amount of liquidated damages assessed and all other information necessary to fully explain the assessment of liquidated damages. 15. In the last five years has your firm, or any firm with which any of your company's owners, officers or partners was associated, been debarred, disqualified, removed or otherwise prevented from bidding on, or completing, any government agency or public construction project for any reason? NOTE: "Associated with" refers to another construction firm in which an owner, partner or officer of your firm held a similar position,and which is listed in response to question lc or Id on this form. n Yes ® No If"yes," explain on a separate signed page. State whether the firm involved was the firm applying for pre-qualification here or another firm. Identify by name of the company, the name of the person within your firm who was associated with that company, the year of the event, the owner of the project,the project and the basis for the action. 16. In the last five years has your firm been denied an award of a public construction contract based on a finding by a public agency that your company was not a responsible bidder? ❑ Yes © No If"yes," explain on a separate signed page. Identify the year of the event, the owner, the project and the basis for the finding by the public agency. * * * * * 8 NOTE: The following two questions refer only to disputes between your firm and the owner of a project.You need not include information about disputes between your firm and a supplier,another contractor,or subcontractor. You need not include information about"pass-through" disputes in which the actual dispute is between a sub-contractor and a project owner. (deleted Also, you may omit reference to all disputes about amounts less than $50,00) 17. In the past five years has any claim against your firm concerning your firm's work on a construction project been filed in court or arbitration? ❑ Yes x❑ No If"yes," on separate signed sheets of paper identify the claim(s) by providing the project name,date of the claim,name of the claimant,a brief description of the nature of the claim, the court in which the case was filed and a brief description of the status of the claim (pending or, if resolved, a brief description of the resolution). 18. In the past five years has your firm made any claim against a project owner concerning work on a project or payment for a contract and filed that claim in court or arbitration? ❑ Yes x❑ No If"yes," on separate signed sheets of paper identify the claim by providing the project name, date of the claim, name of the entity(or entities) against whom the claim was filed, a brief description of the nature of the claim, the court in which the case was filed and a brief description of the status of the claim (pending, or if resolved, a brief description of the resolution). * * * * * 19. At any time during the past five years, has any surety company made any payments on your firm's behalf as a result of a default,to satisfy any claims made against a performance or payment bond issued on your firm's behalf, in connection with a construction project, either public or private? ❑ Yes x❑ No If"yes," explain on a separate signed page the amount of each such claim, the name and telephone number of the claimant, the date of the claim, the grounds for the claim, the present status of the claim, the date of resolution of such claim if resolved, the method by which such was resolved if resolved, the nature of the resolution and the amount, if any,at which the claim was resolved. 20. In the last five years has any insurance carrier, for any form of insurance, refused to renew the insurance policy for your firm'? ❑ Yes ❑x No If"yes,"explain on a separate signed page. Name the insurance carrier, the form of insurance and the year of the refusal. 9 Criminal Matters and Related Civil Suits 21. Has your firm or any of its owners,officers or partners ever been found liable in a civil suit or found guilty in a criminal action for making any false claim or material misrepresentation to any public agency or entity? ❑ Yes x[ No If"yes," explain on a separate signed page, including identifying who was involved, the name of the public agency, the date of the investigation and the grounds for the finding. 22. Has your firm or any of its owners, officers or partners ever been convicted of a crime involving any federal, state, or local law related to construction? n Yesx❑ No If"yes,"explain on a separate signed page,including identifying who was involved,the name of the public agency, the date of the conviction and the grounds for the conviction. 23. Has your firm or any of its owners, officers or partners ever been convicted of a federal or state crime of fraud, theft, or any other act of dishonesty? ❑ Yes ❑x No If"yes," identify on a separate signed page the person or persons convicted, the court (the county if a state court, the district or location of the federal court), the year and the criminal conduct. Bonding 24. Bonding capacity: Provide documentation from your surety identifying the following: Name of bonding company/surety: *see attached Name of surety agent, address and telephone number: 25. If your firm was required to pay a premium of more than one per cent for a performance and payment bond on any project(s) on which your firm worked at any time during the last three years, state the percentage that your firm was required to pay. You may provide an explanation for a percentage rate higher than one per cent, if you wish to do so. 26. List all other sureties(name and full address)that have written bonds for your firm during the last five years, including the dates during which each wrote the bonds: 10 If"yes," attach a separate signed page describing each citation. 31. How often do you require documented safety meetings to be held for construction employees and field supervisors during the course of a project? Minimum weekly,special circumstances may require daily 32. List your firm's Experience Modification Rate (EMR) (California workers' compensation insurance) for each of the past three premium years: NOTE: An Experience Modification Rate is issued to your firm annually by your workers' compensation insurance carrier. Current year: Previous year: Year prior to previous year: If your EMR for any of these three years is or was 1.00 or higher you may, if you wish, attach a letter of explanation. 33. Within the last five years has there ever been a period when your firm had employees but was without workers' compensation insurance or state-approved self-insurance? ❑ Yes x❑ No If"yes," please explain the reason for the absence of workers' compensation insurance on a separate signed page. If "No," please- provide a statement by your current workers' compensation insurance carrier that verifies periods of workers' compensation insurance coverage for the last five years. (If your firm has been in the construction business for less than five years, provide a statement by your workers' compensation insurance carrier verifying continuous workers' compensation insurance coverage for the period that your firm has been in the construction business.) Prevailing Wage and Apprenticeship Compliance Record 34. Has there been more than one occasion during the last five years in which your firm was required to pay either back wages or penalties for your own firm's failure to comply with the state's prevailing wage laws? NOTE: This question refers only to your own firm's violation of prevailing wage laws, not to violations of the prevailing wage laws by a subcontractor. ❑ Yes 0 No If "yes," attach a separate signed page or pages, describing the nature of each violation, identifying the name of the project, the date of its completion, the public agency for which it was constructed; the number of employees who were initially underpaid and the amount of back wages and penalties that you were required to pay. I2 35. During the last five years,has there been more than one occasion in which your own firm has been penalized or required to pay back wages for failure to comply with the federal Davis- Bacon prevailing wage requirements? ❑ Yes Q No "see attached" If "yes," attach a separate signed page or pages describing the nature of the violation, identifying the name of the project,the date of its completion, the public agency for which it was constructed; the number of employees who were initially underpaid, the amount of back wages you were required to pay along with the amount of any penalty paid. 36. Provide the name, address and telephone number of the apprenticeship program (approved by the California Apprenticeship Council) from whom you intend to request the dispatch of apprentices to your company for use on any public work project for which you are awarded a contract by Costa Mesa Sanitary District. 37. If your firm operates its own State-approved apprenticeship program: (a) Identify the craft or crafts in which your firm provided apprenticeship training in the past year. (b) State the year in which each such apprenticeship program was approved,and attach evidence of the most recent California Apprenticeship Council approval(s) of your apprenticeship program(s). (c) State the number of individuals who were employed by your firm as apprentices at any time during the past three years in each apprenticeship and the number of persons who, during the past three years, completed apprenticeships in each craft while employed by your firm. 38. At any time during the last five years, has your firm been found to have violated any provision of California apprenticeship laws or regulations, or the laws pertaining to use of apprentices on public construction? NOTE: You may omit reference to any incident that occurred prior to January 1, 1998,if the violation was by a subcontractor and your firm, as general contractor on a project, had no knowledge of the subcontractor's violation at the time they occurred. 13 Yes 0 No If"yes," provide the date(s) of such findings, and attach copies of the Department's final decision(s). PART III. RECENT CONSTRUCTION PROJECTS COMPLETED Contractor shall provide information about its six most recently completed projects of the same size and scope. Please identify if the project was public or private. Names and references must be current and verifiable. For each, list the number of change orders, the change in cost and the aggregate change in cost for the project. Use separate sheets of paper that contain all of the following information: Project Name: FXG Moses Lake Expansion 5178 Randolph Rd.NE, Moses Lake,WA 98837 Location: Owner: FedEx Ground Package Systems,Inc. Owner Contact(name and current phone number): Kevin Stanley 412/262-6270 Architect or Engineer: Womer&Associates Architect or Engineer Contact(name and current phone number): Womer&Associates 509'534-4884 Construction Manager(name and current phone number): N/A Description of Project, Scope of Work Performed: Warehouse Expansion,Administrative Office Expansion/Renovation &Site Improvements Total Value of Construction (including change orders): Original tract=S 970,207.00 ., :r. .,588.50 Total ontract= S1,194,7'.. 0 14 Original Scheduled Completion Date: 10/31/14 Time Extensions Granted(number of days): 343 calendar days Actual Date of Completion: 10/09/15 I, the undersigned,certify and declare that I have read all the foregoing answers to this prequalification questionnaire and know their contents. The matters stated in the questionnaire answers are true of my own knowledge and belief, except as to those matters stated on information and belief, and as to those matters I believe them to be true. I declare under penalty of perjury under the laws of the State of California,that the foregoing is correct. Dated: (Name) ,f. 5 ❑ Yes x❑ No If"yes," provide the date(s) of such findings, and attach copies of the Department's final decision(s). PART III. RECENT CONSTRUCTION PROJECTS COMPLETED 1. Contractor shall provide information about its six most recently completed projects of the same size and scope. Please identify if the project was public or private. Names and references must be current and verifiable. For each, list the number of change orders, the change in cost and the aggregate change in cost for the project. Use separate sheets of paper that contain all of the following information: Project Name: Golden Crest Building Location: 1825 N. Bronson Avenue, Los Angeles, CA Owner: Church of Scientology Owner Contact(name and current phone number): Jack Kruchko 323/632-0952 Architect or Engineer: Kamus& Keller Q3 Engineering. Inc. Architect or Engineer Contact(name and current phone number): Kamus & Keller-Cory Antila- 805/583-5935 Q3 Engineers, Inc. - Robert Morales- 714/258-6901 Construction Manager(name and current phone number): Gensler- Gary Downer 310/583-5935 Description of Project, Scope of Work Performed: Conversion of a 3 story 65 unit 1950's apartment building into a modem hotel, including modernization of elevator, electrical & mechanical systems. Total Value of Construction (including change orders): Original Contract= $3,759,790.00 Change Orders= $ 749,840.42 Total Contract= $4,509,630.42 14 Original Scheduled Completion Date: 8/04/14 Time Extensions Granted(number of days): 432 calendar days Actual Date of Completion: 10/09/15 I,the undersigned,certify and declare that I have read all the foregoing answers to this prequalification questionnaire and know their contents. The matters stated in the questionnaire answers are true of my own knowledge and belief, except as to those matters stated on information and belief, and as to those matters I believe them to be true. I declare under penalty of perjury under the laws of the State of California,that the foregoing is correct. Dated: (Name) 15 ❑ Yes 0 No If"yes," provide the date(s) of such findings, and attach copies of the Department's final decision(s). PART III. RECENT CONSTRUCTION PROJECTS COMPLETED 1. Contractor shall provide information about its six most recently completed projects of the same size and scope. Please identify if the project was public or private. Names and references must be current and verifiable. For each, list the number of change orders, the change in cost and the aggregate change in cost for the project. Use separate sheets of paper that contain all of the following information: Project Name: Bridge Publications Archival Manufacturing T.I. Location: 5600 East Olympic Blvd.,City of Commerce,CA 90022 Owner: Bridge Publications Owner Contact(name and current phone number): Jaime McClintock-email:jmcrscientology.net 323/888-6200 Architect or Engineer: RGA Office of Architectural Design Architect or Engineer Contact(name and current phone number): Dennis Roy 949/341-0920 Construction Manager(name and current phone number): Gensler-Davor Dakic 213/327-3704 Description of Project, Scope of Work Performed: Construction of a recording and preservation line. Including all process piping, clean room construction,including air scrubbing,upgraded electrical& mechanical systems. Total Value of Construction(including change orders): Original Contract=S2,652,959.50 Change Orders =S 136,787.36 Total Contract =S2,789.746.86 14 Original Scheduled Completion Date: 11/05/14 Time Extensions Granted(number of days): 15 calendar days Actual Date of Completion: 11,20/14 I,the undersigned,certify and declare that I have read all the foregoing answers to this prequalification questionnaire and know their contents. The matters stated in the questionnaire answers are true of my own knowledge and belief, except as to those matters >' stated on information and belief, and as to those matters I believe them to be true. I declare under penalty of perjury under the laws of the State of California,that the foregoing is correct. Dated: (Name) 15 ❑ Yes x❑ No If"yes," provide the date(s) of such findings, and attach copies of the Department's final decision(s). PART III. RECENT CONSTRUCTION PROJECTS COMPLETED 1. Contractor shall provide information about its six most recently completed projects of the same size and scope. Please identify if the project was public or private. Names and references must be current and verifiable. For each. list the number of change orders, the change in cost and the aggregate change in cost for the project. Use separate sheets of paper • that contain all of the following information: Project Name: FedEx Anaheim CY 14 Facility Expansion Location: 590 E. Orangethorpe Avenue, Anaheim, CA 92805 Owner: FedEx Ground Package System, Inc. Owner Contact(name and current phone number): Chas Ainsworth 412/859-2644 Architect or Engineer: Milburn Architecture_ Inc. Architect or Engineer Contact(name and current phone number): John Milburn 916i622-3232 Construction Manager(name and current phone number): N/A Description of Project, Scope of Work Performed: General building renovation& indoor parking,security office, trailer parking and ADA parking modifications,site work-trialer parking,fences/gates,mechanical,electrical&plumbing systems asphalt pavement including aggregate base course,and concrete pavements. Total Value of Construction(including change orders): Original Contract=$ 879,500.00 Change Orders =S 202,442.00 Total Contract =$1,081,942.00 14 Original Scheduled Completion Date: 10/31:14 Time Extensions Granted(number of days): 396 calendar days Actual Date of Completion: 09/30/15 I,the undersigned,certify and declare that I have read all the foregoing answers to this prequalification questionnaire and know their contents. The matters stated in the questionnaire answers are true of my own knowledge and belief, except as to those matters stated on information and belief, and as to those matters I believe them to be true. I declare under penalty of perjury under the laws of the State of California,that the foregoing is correct. Dated: (Name) 15 ❑ Yes E No If"yes," provide the date(s) of such findings, and attach copies of the Department's final decision(s). PART III. RECENT CONSTRUCTION PROJECTS COMPLETED I. Contractor shall provide information about its six most recently completed projects of the same size and scope. Please identify if the project was public or private. Names and references must be current and verifiable. For each, list the number of change orders, the change in cost and the aggregate change in cost for the project. Use separate sheets of paper that contain all of the following information: Project Name: FedEx Ground-Rialto(RLTO#923)CY15 Parking Expansion Location: 330 Resource Drive,Bloomington,CA 92316 Owner: FedEx Ground Package System, Inc. Owner Contact(name and current phone number): William D. Paoleschi, P.E. 412;262-6240 Architect or Engineer: RGA,Office of Architecture Design, Inc. Architect or Engineer Contact(name and current phone number): Dennis Roy 949/341-0920 Construction Manager(name and current phone number): N/A Description of Project, Scope of Work Performed: Parking Expansion: demolition,landscaping,site work, grading,asphalt paving,HC striping/signage, fencing,concrete,and electrical work. Total Value of Construction(including change orders): Original Contract=$620,300.00 Change Orders =$ 72,125.14 Total Contract =$692,425.14 14 Original Scheduled Completion Date: 11116/15 Time Extensions Granted(number of days): None Actual Date of Completion: 11 09/15 I,the undersigned,certify and declare that I have read all the foregoing answers to this prequalification questionnaire and know their contents. The matters stated in the questionnaire answers are true of my own knowledge and belief, except as to those matters stated on information and belief, and as to those matters I believe them to be true. I declare under penalty of perjury under the laws of the State of California,that the foregoing is correct. Dated: Please see the next page for signature. (Name) 15 Original Scheduled Completion Date: Time Extensions Granted(number of days): Actual Date of Completion: * * * * * * * I,the undersigned,certify and declare that I have read all the foregoing answers to this prequalification questionnaire and know their contents. The matters stated in the questionnaire answers are true of my own knowledge and belief, except as to those matters stated on information and belief, and as to those matters I believe them to be true. I declare under penalty of perjury under the laws of the State of California,that the foregoing is correct. Dated: t�I.._��Ii�i.,•.- 15 ❑ Yes ❑x No If"yes," provide the date(s) of such findings, and attach copies of the Department's final decision(s). PART III. RECENT CONSTRUCTION PROJECTS COMPLETED 1. Contractor shall provide information about its six most recently completed projects of the same size and scope. Please identify if the project'was public or private. Names and references must be current and verifiable. For each, list the number of change orders, the change in cost and the aggregate change in cost for the project. Use separate sheets of paper that contain all of the following information: Project Name: Fountain Building Location: 4816 Fountain Avenue, Los Angeles,CA 90027 Owner: Church of Scientology Owner Contact(name and current phone number): Jack Kruchko 323/632-0952 Architect or Engineer: Kamus &Keller Q3 Engineers, Inc. Architect or Engineer Contact(name and current phone number): Kamus&Keller - Cory Antila - 805/583-5935 Q3 Engineers - Robert Morales - 714/258-6901 Construction Manager(name and current phone number): Gensler - Gary Downer 310/583-5935 Description of Project, Scope of Work Performed: Conversion of a 4 story,90 unit 1950's apartment building into a modern hotel. Including modernization of elevator, electrical&mechanical systems. Total Value of Construction (including change orders): Original Contract= $3,825,850.00 CO's 1 through 30=$ 593,907.86 Total Contract= $4,419,757.86 14 Original Scheduled Completion Date: October 31,?ot4 Time Extensions Granted(number of days): 64 days due to change order work Actual Date of Completion: January 29,2015 I,the undersigned,certify and declare that I have read all the foregoing answers to this prequalification questionnaire and know their contents. The matters stated in the questionnaire answers are true of my own knowledge and belief, except as to those matters stated on information and belief, and as to those matters I believe them to be true. I declare under penalty of perjury under the laws of the State of California,that the foregoing is correct. Dated: (Name) 15 27. During the last five years,has your firm ever been denied bond coverage by a surety company, or has there ever been a period of time when your firm had no surety bond in place during a public or private construction project when one was required? ❑ Yes n No If yes, provide details on a separate signed sheet indicating the date when your firm was denied coverage and the name of the company or companies which denied coverage; and the period during which you had no surety bond in place. C. Compliance with Occupational Safety and Health Laws and with Other Labor Legislation Safety 28. Has CAL OSHA cited and assessed penalties against your firm for any"serious,""willful" or`repeat"violations of its safety or health regulations in the past five years? NOTE: If you have filed an appeal of a citation,and the Occupational Safety and Health Appeals Board has not yet ruled on your appeal,you need not include information about it. ❑ Yes 0 No If"yes," attached a separate signed page describing the citations, including information about the dates of the citations, the nature of the violation, the project on which the citation(s) was or were issued, the amount of penalty paid, if any. If the citation was appealed to the Occupational Safety and Health Appeals Board and a decision has been issued, state the case number and the date of the decision. 29. Has the federal Occupational Safety and Health Administration cited and assessed penalties against your firm in the past five years? NOTE: If you have filed an appeal of a citation and the Appeals Board has not yet ruled on your appeal, or if there is a court appeal pending, you need not include information about the citation. ❑ Yes Q No If"yes," attach a separate signed page describing each citation. 30. Has the EPA or any Air Quality Management Distnct or any Regional Water Quality Control Board cited and assessed penalties against either your firm or the owner of a project on which your firm was the prime or subcontractor, in the past five years? NOTE: If you have filed an appeal of a citation and the Appeals Board has not yet ruled on your appeal, or if there is a court appeal pending,you need not include information about the citation. El Yes 0No II II J SureTec June 22, 2016 To Whom it May Concern Re: James H. Kinney, Inc. dba: Kinney Construction It is our understanding that the above captioned firm has requested to be prequalified to bid construction projects to you. This will confirm that SureTec Insurance Company is willing to favorably consider the issuance of required Performance & Payment Bonds subject to our satisfaction with the contract documents and bond forms and continuing to satisfy other underwriting considerations. , SureTec will favorably consider single bonds up to $2,000,000 and aggregate work programs of $5,000,000. Issuance of any bid, performance or payment bond is a matter between our principal and us. No claims have been made on any bonds. Any arrangement for bonds required by the contract is a matter between this principal and the surety and we assume no liability to you or third parties if for any reason we do not execute any bonds. incerely, Dave B RoalKvam Vice President, Sr. Underwriter and Attorney-In-Fact SureTec Insurance Company 3033 5th Avenue, Suite 300 San Diego, CA 92103 619-400-4100 POA#: 510015 SureTec Insurance Company # LIMITED POWER OF ATTORNEY Know All Men by These Presents, That SURETEC INSURANCE COMPANY (the "Company"), a corporation duly organized and existing under the laws of the State of Texas, and having its principal office in Houston, Harris County, Texas, does by these presents make,constitute and appoint Ron H. Ballard,Gloria S.Becerra, Dave B. Roalkvam, David Melman,Albert Espino,Arianne Adair I its true and lawful Attorney-in-fact,with full power and authority hereby conferred in its name,place and stead,to execute,acknowledge and deliver any and all bonds, recognizances, undertakings or other instruments or contracts of suretyship to include waivers to the conditions of contracts and consents of surety for: Fifteen Million and 00/100 Dollars($15,000,000.00) and to bind the Company thereby as fully and to the same extent as if such bond were signed by the President,sealed with the corporate seal of the Company and duly attested by its Secretary,hereby ratifying and confirming all that the said Attorney-in-Fact may do in the premises. Said appointment shall continue in force until 05/18/17 and is made under and by authority of the following resolutions of the Board of Directors of the SureTec Insurance Company: Be it Resolved that the President,any Vice-President,any Assistant Vice-President, any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attomey(s)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions: Attorney-in-Fact may be given full power and authority for and in the name of and of behalf of the Company,to execute,acknowledge and deliver,any and all bonds,recognizances,contracts,agreements or indemnity and other conditional or obligatory undertakings and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorney-in-Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary. Be it Resolved that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile,and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached. (Adopted at a meeting held on 20°1 of April, 1999.) In Witness Whereof, SURETEC INSURANCE COMPANY has caused these presents to be signed by its President,and its corporate seal to be hereto affixed this 21st day of March,A.D.2013. SURETEC INSURANCE COMPANY SURANc, tibj/`Iq Oz. By. tel t w� I John ox Jr resident State of.xas ._- ss: ?#\,..-1 ;'.r Count of Harris �•- ,. On this 21st day of March,A.D.2013 before me personally came John Knox Jr.,to me known,who,being by me duly sworn,did depose and say,that he resides in Houston, Texas, that he is President of SURETEC INSURANCE COMPANY, the company described in and which executed the above instrument;that he knows the seal of said Company;that the seal affixed to said instrument is such corporate seal;that it was so affixed by order of the Board of Directors of said Company;and that he signed his name thereto by like order. ,'yet,• JACQUELYN MALDONADO �l y ,n� 1 Notary Public / '. ?C-- 1 v State of Texas 'to" My Comm.Exp.5/18/2017 Jacq elyn Maldonado,Notary Public My commission expires May 18,2017 I,M.Brent Beaty,Assistant Secretary of SURETEC INSURANCE COMPANY,do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney,executed by said Company,which is still in full force and effect;and furthermore,the resolutions of the Board of Directors,set out in the Power of Attorney arc in full force and effect. Given under my hand and the seal of said Company at Houston, Texas this 22nd day of June . 2016 ,A.D. f / .Bre.t Beaty,Assistant ecretary Any instrument Issued In excess of the penalty stated above is totally void and without any validity. For verification of the authority of this power you may call(713)812-0800 any business day between 8:00 am and 5:00 pm CST. CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness, accuracy,or validity of that document. State of California County of San Diego On June 22,2016 before me, Jessica Donaghe , Notary Public personally appeared Dave B. Roalkvam who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) islace subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ics), and that by his/h.,, hem signatures-) on the instrument the person(s), or the entity upon behalf of which the persons)acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws y` of the State of California that the foregoing paragraph is true and correct. • JESSICA DONAGHE \4WEV NOTARY PUBLIC-CALIFORNIA - - COMMISSION#2084540 WITNESS)Thy ha tcial seal. �?! SAN DIEGO COUNTY ?n• *Comm.Exp.April/5,PMA S. nature 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 15 ❑ INDIVIDUAL ❑ CORPORATE OFFICER Title or Type of Document ❑ PARTNER(S) Number of Pages ❑ MEMBER of LLC ® ATTORNEY-IN-FACT ❑ TRUSTEE(S) ❑ GUARDIAN/CONSERVATOR Date of Document OTHER: SIGNER IS REPRESENTING: Signer(s)other than named above NAME OF PERSON(S)OR ENTITY(IES) SureTec Insurance Company BBSI June 22, 2016 To Whom It May Concern: James H. Kinney Inc., dba Kinney Construction entered a co-employment relationship with BBSI in July of 2009, and therefore BBSI has maintained the workers' compensation coverage for all of their personnel since that time. Although BBSI was self-insured for workers' compensation in the State of CA until 1/1/15 and therefore not required to derive and report experience modification information to the WCIRB, we do have an internal system that allows us to replicate an experience modification rating using a client's payroll, premium and loss information. The aforementioned Kinney Construction has been in this relationship with BBSI since July of 2009 and since then we have had a good claim experience with them. If we sere to report information regarding an experience modification rating. their rating (using our internal calculation) would be .98 for this past three year period. As you know, ratings are an accumulation of experience over the past 3 years, excluding the current year, so we are offering our experience information from their time with BBSI. Please feel free to contact me with any questions at 949-255-5322. Sincerely, le%t/1.7; Leslie Perry Area Manager BBSI Santa Ana Internally Prepared Balance Sheet -� 01/20/16 Kinney Construction Balance Sheet Period 12 At October 2016 Assets Current Assets 1040 CASH IN UBC $341,428.45 1070 CASH IN UBC-PAYROLL 256.25 1071 401K ACH CLEARING 2,633.00 1099 PETTY CASH 500.00 1110 A/R TRADE 4,123,643.97 Total Current Assets: $4,468,461.67 Long Term Assets 1801 VEHICLES 488,392.00 1802 MACHINERY&EQUIPMENT 30,299.00 1811 ACCUM. DEPREC.-FEE (363,340.00) 1820 COMPUTER EQUIPMENT 50,452.00 1830 LEASEHOLD IMPROVEMENTS 179,308.00 Total Long Term Assets: 385,111.00 Net Long Term Assets: 385,111.00 Other Assets 1760 FORM 8752 DEPOSIT 34,417.00 Total Other Assets: 34,417.00 Total Assets: $4,887,989.67 Liabilities Current Liabilities 2110 AP-TRADE 1,366,257.90 Report 2-2-0-21 01/20/16 kristy Page 1 06:24 PM 4 Balance Sheet 01/20/16 Continued... 2111 UNEARNED WIP 70,551.39 2112 ACCRUED NP 350,959.84 2119 PAYROLL PAYABLE-ODD 24,981.76 2210 ACCRUED COMPENSATION 163,454.40 2222 ACCRUED VACATION 15,267.08 2230 ACCRUED EXPENSE-LIABILITY INS. (3,527.36) 2240 STATE TAX PAYABLE 7,676.00 2310 LIAB INSURANCE PAYABLE 2,606.53 2501 AMEX-CORP 5,677.45 Total Current Liabilities: 2,003,904.99 Long Term Liabilities 2613 2015 FORD F150 LOAN PAYABLE 17,985.40 2614 2016 AUDI LOAN PAYABLE 66,423.95 2616 2014 FORD F350 LOAN PAYABLE 31,182.73 2617 2015 FORD F450 LOAN PAYABLE 39,530.03 2618 2014 VOLVO LOAN PAYABLE 31,646.53 2619 2015 CADILLAC LOAN PAYABLE 38,874.41 2800 UNION BANK LOAN#6058 55,697.33 2801 UNION BANK LOAN#0515 153,800.94 Total Long Term Liabilities: 435,141.32 Total Liabilities: 2,439,046.31 Equity Equity/Capital 3110 COMMON STOCK 1,000.00 3120 RETAINED EARNINGS 2,434,903.78 Subtotal Equity/Capital: 2,435,903.78 Current Profit(Loss): 13,039.58 Total Equity/Capital: 2,448,943.36 Total Liabilities+Equity: $4,887,989.67 Report 2-2-0-21 01/20/16 kristy Page 2 of 2 06:25 PM Internally Prepared Income Statement 01/20/16 Kinney Construction Income Statement Period and YTD For 1 Month Ending October 2015 Period %Income Year %Income Operating Income SALES CONTRACTS 1,006,040.33 94.85 % 12,412,956.01 98.38 % 0 OVER/UNDER BILL ADJUST 54,555.67 5.14 % 203,590.68 1.61 0 DISCOUNT EARNED 42.50 0.00 % 989.32 0.01 Total Operating Income: 1,060,638.50 100.00 % 12,617,536.01 100.00 % Direct Expense MATERIAL EXPENSE 103,813.66 9.79 % 1,112,461.54 8.82 LABOR EXPENSE 179,746.14 16.95 % 1,550,130.19 12.29 0 EQUIPMENT EXPENSES 35,711.23 3.37 % 179,435.60 1.42 0 SUBCONTRACT LABOR 541,989.46 51.10 % 7,725,172.86 61.23 OTHER GENERAL EXPENSES 112,903.05 10.64 % 457,301.39 3.62 % INSURANCE EXPENSE 2,809.57 0.26 % 27,366.68 0.22 % FEES/PLANS EXPENSE 3,211.47 0.30 % 51,720.21 0.41 % REIMBURSEABLE EXPENSE 0.00 0.00 % 407.69 0.00 Total Direct Expense: 980,184.58 92.41 % 11,103,996.16 88.00 % Equip/Shop Expense HAND TOOLS (926.49) -0.09 % 13,941.67 0.11 % SAFETY EQUIPMENT 0.00 0.00 % 664.00 0.01 % TRAFFIC CONTROL EQUIPMENT 0.00 0.00 % 1,987.20 0.02 % TRUCK REPAIR/FUEL 1,770.97 0.17 % 57,205.22 0.45 % Total Equip/Shop Expense: 844.48 0.08 % 73,798.09 0.58 Total Direct&Equip/Shop Expense: 981,029.06 92.49 % 11,177,794.25 88.59 % Gross Profit: 79,609.44 7.51 % 1,439,741.76 11.41 % Overhead Expense BIDDING EXPENSE 0.00 0.00 % 4,580.41 0.04 1 16 /20/ Report 2-3-0-31 01/20/16 01/22 16 kristy Page 1 Income Statement 01/20/16 Continued... Period %Income Year %Income RECRUITMENT 3,000.00 0.28 % 9,305.00 0.07 % Total Overhead Expense: 3,000.00 0.28 % 13,885.41 0.11 % Administrative Expense COMPENSATION 47,179.61 4.45 % 623,528.56 4.94 % PAYROLL TAXES 3,597.74 0.34 % 54,913.86 0.44 % MEDICAL INSURANCE 4,720.03 0.45 % 66,952.73 0.53 % 401K (1,221.30) -0.12 % 41,606.38 0.33 % EDUCATION/SEMINAR 1,355.21 0.13 % 5,534.16 0.04 % WORKERS COMP INSURANCE 491.38 0.05 % 8,923.42 0.07 % EMPLOYEE BENEFITS 5,250.00 0.49 % 51,088.81 0.40 % VEHICLE REIMBURSEMENT 0.00 0.00 % 4,750.00 0.04 BANK FEES 490.36 0.05 % 1,811.04 0.01 % VEHICLE GAS/OIL 1,685.11 0.16 % 17,793.87 0.14 % VEHICLE MAINT/REPAIR 0.00 0.00 % 13,466.40 0.11 VEHICLE LEASE EXPENSE 513.71 0.05 % 6,164.52 0.05 BUSINESS PROMOTION 2,403.35 0.23 % 20,900.44 0.17 MEALS/ENTERTAINMENT (240.46) -0.02 % 19,450.77 0.15 % OFFICE RENT 5,650.00 0.53 % 66,150.00 0.52 °A, OFFICE TELEPHONE 224.64 0.02 % 2,599.46 0.02 % ELECTRICITY 571.58 0.05 °A, 5,265.09 0.04 % TRASH SERVICE 39.19 0.00 % 470.28 0.00 % WATER 67.09 0.01 % 423.08 0.00 °Ao TEMPORARY OFFICE HELP 10,340.85 0.97 % 54,375.67 0.43 % OFFICE SECURITY 44.00 0.00 % 678.00 0.01 % OFFICE CLEANING 145.00 0.01 % 2,042.00 0.02 °A° PAYROLL FEES 2,058.12 0.19 % 10,180.79 0.08 % COMP INTERNET FEES 448.95 0.04 % 5,461.93 0.04 % COMP MAINT/REPAIR (4,786.87) -0.45 % 15,383.10 0.12 OFFICE EQUIP SRVC/REPAIR 560.99 0.05 % 6,252.15 0.05 % TAXES LIC&FEES 7,156.71 0.67 % 28,912.93 0.23 % 4 DUES/SUBSCRIPTIONS 1,284.07 0.12 % 3,868,02 0.03 % OFFICE SUPPLIES 2,023.49 0.19 % 18,010.83 0.14 % POSTAGE 201.36 0.02 % 4,406.03 0.03 LEGAL FEES 1,416.00 0.13 % 59,655.99 0.47 °A° ACCOUNTING FEES 95.00 0.01 % 23,787.50 0.19 % NOTARY FEES 0.00 0.00 % 98.00 0.00 % 401KADMIN FEES 0.00 0.00 % 8,954.00 0.07 % CONTRIBUTIONS/DONATIONS 152.00 0.01 % 9,602.00 0.08 INSURANCE 1,791.60 0.17 % 21,542.25 0.17 % PROPERTY MAINTENANCE 215.00 0.02 % 1,625.00 0.01 % DEPRECIATION 47,798.19 4.51 % 70,574.00 0.56 % Report 2-3-0-31 01/20/16 kristy Page 2 06:22 PM Income Statement 01/20/16 I Continued... Period %Income Year %Income Total Administrative Expense: 143,721.70 13.55 % 1,357,203.06 10.76 Total Indirect Expense: 146,721.70 13.83 % 1,371,088.47 10.87 % Income from Operations: (67,112.26) -6.33 % 68,653.29 0.54 % Other Income PROFIT/LOSS ON DISPOSED ASSETS (6,146.00) -0.58 % (29,702.00) -0.24 Total Other Income: (6,146.00) -0.58 % (29,702.00) -0.24 % Net Income Before Tax: (73,258.26) -6.91 % 38,951.29 0.31 % After Tax Expense LT LOAN INTEREST EXPENSE 411.03 0.04 % 2,538.45 0.02 % BANK INTEREST EXPENSE 1,074.90 0.10 % 14,788.26 0.12 STATE TAX EXPENSE 6,855.00 0.65 % 8,585.00 0.07 Total After Tax Expense: 8,340.93 0.79 % 25,911.71 0.21 Net Income: (81,599.19) -7.69 % 13,039.58 0.10 % Report 2-3-0-31 01/20/16020 PM kristy Page 3 of 3