Project 129 - Proposal - Repipe-CA, Inc. COSTA MESA SANITARY DISTRICT
ORANGE COUNTY CALIFORNIA
BID PROPOSAL FORM
BRISTOL STREET SEWER REPLACEMENT
PHASE II
Project No 129
Name of Bidder -R2pp2 - CA Inc.
Address: 5525 E. GI 6,-Q 14-a I-- 5).reel. dri4-ariol CA if 744
Phone No. (qty' Z9(— 4O(oz.
TO THE BOARD OF DIRECTORS
COSTA MESA SANITARY DISTRICT
Pursuant to and in compliance with the Notice Inviting Sealed Proposals (Bids) and the other documents
relating thereto, the undersigned bidder has carefully examined and is completely familiar with the plans,
specifications, and contract documents including the local conditions affecting the performance of the
contract, the character, quality quantities, and scope of the work, and the materials to he furnished as to
the requirements of the specifications and the contract.
If awarded the contract, the undersigned bidder hereby proposes and agrees to perform within the time
stipulated in the contract, including all of its component parts and everything required to be performed,
and to furnish any and all of the labor, material, tools, equipment, transportation, services, permits,
utilities, and all other items necessary to perform the contract and complete in a workmanlike manner, all
of the work required in connection with the construction of said work all in strict conformity with the
plans and specifications and other contract documents, including addenda Nos. ( , _,_, and ,
on file in the District office for the prices hereinafter set forth.
The undersigned as bidder, declares that the only persons or parties interested in this proposal as
principals are those named herein; that this proposal is made without collusion with any person, firm, or
corporation; and he proposes and agrees, if the proposal is accepted, that he will execute a contract with
the District in the form set forth in the contract documents and that he will accept in full payment thereof
the following prices, to wit:
CMSD Project No. 129 Bid Proposal Form— 1 of 10
k,
CMSD SEWER REPLACEMENT PROJECT NO. 129
SCHEDULE OF WORK ITEMS (SCHEDULE A)
BRISTOL STREET SEWER REPLACEMENT
PHASE II
BID APPROX. DESCRIPTION UNIT TOTAL
ITEM QUANTITY PRICE AMOUNT
1 Lump Sum Bonds, Insurance, and Permits: Work under this item
includes any costs incurred for securing bonds, insurance Lump us)
permits and fmancing for construction work. Sum $ - ,Joe
2 Lump Sum Mobilization, Demobilization and Cleanup: Work under
this item shall include preparatory and cleanup operations
including, but not limited to, those necessary for the
movement of personnel, equipment, materials, and
incidentals to and from the project site, securing a
temporary construction yard, and maintaining the project Lump co
site in a safe and orderly manner during construction. Sum $ 19,50b
3 Lump Sum Traffic Control: Furnish all labor, materials, and
equipment for the installation and removal of the required
traffic control including, but not limited to, changeable
message boards, signs, delineators, traffic cones,
barricades, flashing arrow signs, steel plates, and all other
traffic control devices necessary to comply with the traffic Lump
control drawings. Sum $2-7, 2f0
4 Lump Sum Geotechnical Evaluation During Construction: Work
under this item shall include laboratory testing of trench
backfill, aggregate base, asphalt, and concrete during
construction. Work under this item shall also include the
monitoring of batch time, temperature, mix designs, and
placement time for all pavement replacement.
Note. Contractor shall provide a report(2 copies)of the
geotechnical observation and testing upon project Lump
completion to the District. Sum $S/boa
5 Lump Sum Provide Diversion Plan for Existing Sewage Flow During
Construction: Work under this item shall include, but is
not limited to, pumps, temporary hoses or piping, pumper
trucks, plugs, and all other equipment necessary to provide
diversion of existing sewage flow during construction Lump pu
complete in place. Sum $ 61 OOa
6 Lump Sum Replace Pavement Striping: Work under this item shall
include furnishing and installing all labor material, and
work necessary to replace existing pavement striping
damaged during construction to original condition Lump op
complete in place. Sum $ S aaY_
CMSD Project No. 129 Bid Proposal Form-2 of 10
CMSD SEVER REPLACEMENT PROJECT NO. 129
SCHEDULE OF WORK ITEMS(SCHEDULE A)
BRISTOL STREET SEWER REPLACEMENT
PHASE H
BID APPROX. UNIT TOTAL
DESCRIPTION
ITEM QUANTITY PRICE AMOUNT
7 3 Each Remove existing manhole and Construct
Launching/Receiving Pit for pipe bursting system.
Work under this item shall include furnishing and $ Z� act
installing all labor, material, shoring and work necessary �y
for this item. Each $
8 703 LF Construct 12' IIDPE SDR17 IPS pipe by pipe bursting
method to replace existing 8' VCP sewer per Plans and
Specifications. Contractor Bidding the Project must
Self Perform the Pipe Bursting Operations, have
successfully completed at least 1,500 linear feet of
Sewer Pipe Bursting, or shall submit with Bid
Documents that they will use the Pipe Bursting
Equipment Manufacturer's Technical Representative
to train and support for project start up.
Work under this item shall include furnishing and
installing all labor material, and work necessary to$ tog=°
construct 12' HOPE pipe by pipe bursting method
including pre and post CCTV and pipe cleaning. LF $
9 3 Each Construct 48' Manhole per CMSD Std. Dwg. No. S-100
with Ameron T-Lock Liner System or approved equal on
manhole walls, bases and channels.
Work under this item shall include furnishing and$l p oo3't—`
installing all labor material, and work necessary to
construct new manhole in place. Each $ O,00r)`
10 1 Each Protect existing manhole in place and construct access
pit for pipe bursting if needed.
Work under this item shall include furnishing and
installing all labor, material, and work necessary to $ vino
protect existing manhole in place and construct access
pit. Each $ 2l IR
11 4 Each Reconnect sewer lateral per CMSD Std.Dwg. No. S-104-
A with fusion 1-IDPE saddle.
Work under this item shall include furnishing and $L ocx
installing all labor, material, and work necessary to
reconnect sewer lateral. Each $ Y,00%%°f
-
CMSD Project No. 129 Bid Proposal Form—3 of 10
CMSD SEWER REPLACEMENT PROJECT NO. 129
SCHEDULE OF WORK ITEMS (SCHEDULE A)
BRISTOL STREET SEWER REPLACEMENT
PHASE H
BID APPROX. IDESCRITTION UNIT TOTAL
ITEM QUANTITY PRICE AMOUNT
12 Lump Sum Protect existing IRWD domestic water pipelines in place. to
I
Work under this item shall include furnishing and
Sob
installing all labor, material, and work necessary to protect Lump
the water line in place. Sum $ I 1 SwGo
13 Lump Sum Chip around existing opening in manhole. Connect new
12' IIDPE pipe and mortar patch grout.
Work under this item shall include furnishing and
installing all labor material, and work necessary to Lump
complete this item. Sum $2-15-00
14 Lump Sum Pothole existing 24' RCP Storm Drain prior to
construction and protect storm drain during pipe bursting.
Contractor to provide televising inspection of storm drain
before and after construction.
Work under this item shall include furnishing and
installing all labor, material, and work necessary to Lump
complete this item. Sum $ I 1 -ZSb
+15 Lump Sum Protect existing 16' domestic water pipeline in place per
City on Newport Beach requirements.
$I,Sct
Work under this item shall include furnishing and
installing all labor, material, and work necessary to protect Lump
the water line in place. Sum $ I, Sod
16 Lump Sum Remove Temporary Cap set during soils investigation.
Construct Pavement Replacement per City of Newport
Beach Std-105-L-B and detail on Sheet S of Plans.
Work under this item shall include all material and labor
for pavement replacement including final asphalt concrete Lump S
pavement installation. Sum $ N 0
17 Lump Sum Pavement Replacement per City of Newport Beach Std-
105-L-B and detail on Sheet 5 of Plans.
Work under this item shall include all material and labor
for pavement replacement including final asphalt concrete Lump
pavement installation. Sum $ or
TOTAL AMOUNT OF l] 00
ITEMS 1 THROUGH 17 $ 299,ltb
CMSD Project No. 129 Bid Proposal Form—4 of 10
CMSD SEWER REPLACEMENT PROJECT NO. 129
SCHEDULE OF WORK ITEMS (SCHEDULE A)
BRISTOL STREET SEWER REPLACEMENT
PHASE II
BID APPROX. UNIT TOTAL
DESCRIPTION
ITEM QUANTITY PRICE AMOUNT
Tto-)o{-u-$0 fzet to 131 er K N 1 Nt T14otivWntn %Ul-l\ H cHti o 2€D 0&'i4
(TOTAL IN WORDS—SCHEDULE A)
Bidders hiitialsetiikj
Note: In case of a discrepancy between the words and figures, the words shall prevail.
The Contractor agrees that the District will not be held responsible if any of the approximate
quantities shown in the foregoing proposal shall be found incorrect, and he shall not make any claim for
damages or for loss of profits because of a difference between the quantities of the various classes of
work as estimated and the work actually done. If any error omission or mis-statements shall be
discovered in the estimated quantities, it shall not invalidate this contract or release the Contractor
from the execution and completion of the whole or part of the work herein specified, in accordance with
the specifications and the plans herein mentioned and the prices herein agreed upon and fixed therefor, or
excuse him from any of the obligations or liabilities hereunder, or entitle him to any damages or
compensation otherwise than as provided for in this contract.
The Contractor agrees that the District shall have the right to increase or decrease the quantity of
any bid item or portion of the work or to omit portions of the work as may be deemed necessary or
expedient, and that the payment for incidental items of work, not separately provided in the proposal
shall be considered included in the price bid for other various items of work.
Accompanying this proposal is B tdclutr 15 Zeta
(S to'!. ).
NOTICE: Insert the words 'Cash' 'Certified Check' or 'Bidder s Bond' as the case may be in an
amount equal to at least 10%of the total bid price, payable to the Costa Mesa Sanitary District.
The undersigned deposits the above named security as a proposal guaranty and agrees that it shall
be forfeited to the Costa Mesa Sanitary District as liquidated damages in case this proposal is accepted
by the District and the undersigned shall fail to execute a contract for doing said work and to furnish
good and sufficient bonds in the form set forth in the specifications and contract documents of the
District with surety satisfactory to the District within 10 Days after the bidder has received written
notice of the award of the contract; otherwise, said security shall be returned to the undersigned.
Respectfully submitted,
ppG — CA, lute
Contractor's Business Name Contractor 7 Title
5525 E, G 6ra1{-ar St. �'/// 1/L%t.1 t/ e 'Itce.
Business Address: Street By• Title
Or-arto , CA 917L4 814303 —4
City State Zip Contractor's License, Expiration
CMSD Project No. 129 Bid Proposal Form—5 of 10
Date& Classification
(9 QM) z°Il — 4650
Business Phone Number
Dc%ve 4r-l-burs Vice Pr'e5.
Name Title
76.0) 845-SSzo
Residence Phone Number
(ALa Negt ttov%4 Ptacc
Bidder's Residence: Street
Carbkncl CA ` zct I
City State Zip
I declare under penalty of perjury under the laws of the State of California that the forgoing is true
and correct.
Dated at On+artot CA this Z4T"day of Ccfobra- 20 1.t
/�iIl��1���►ice
(Signed)
The full names and residences of all persons and parties interested in the foregoing proposal, as
principals, are as follows:
NOTICE: Give first and last names in full; in case of corporation, give names of President, Secretary
Treasurer and Manager, and affix corporate seal; in all cases of partnerships and joint ventures give
names of all the individual members.
Toe Ca+t Ito CEO -t-hc, v l lands 7 cct
—Dove 1-Levnt+ret CFO Tk Y•fmc,lane!s -1-rxas
-DAN c_ 4 r±inurs IP (:)„,4-one. CA .
Galifor,,
.s 9,90R4;. J.
2 SEAL n
2002
F,<AVO3'
CMSD Project No. 129 Bid Proposal Form—6 of 10
CONSTRUCTION PROJECT REFERENCES
In order to more fully evaluate your background and experience for the project herein proposed, it is
requested that you submit a list of Public Works and/or similar construction projects completed, or in
progress, within the last 24 months. Your cooperation in this matter is greatly appreciated.
DATE PROJECT AGENCY'S CONTRACT
AW&RDED AWARDING AGENCY ADMINISTRATOR
SEE K-trikCH-6D
PROJECT ADDENDA
Bidder shall signify receipt of all Addenda here, if any
ADDENDUM NO. DATE RECEIVED BIDDER'S SIGNATURE
1 )0(14 /II / (A
CMSD Project No. 129 Bid Proposal Form—7 of 10
ORMETruncated Reference List
AN IPG CO'
Name and Address of Owner Project Name Pipe Size Lengths Liner System Completed
City of Lo Angels Va ASRP Projects 8,10,12 15,18 276,531 Natio at Lir r CIPP 2003-7
11495 Br adv ay SSRP S02A&SO2B 8,10 21,486 Natio at Lin r CIPP 2007
Los Angela CA 90014 SSRP C04A Ro a Au 8,10,12 4,665 Natio at Lir r CIPP 2008
Contact Iftekhar Ahmed SSRP U04A Be edywood 8 9,053 Natio al Lin r CIPP 2008
Pho (213)485-5875 SSRP H27B Melr e Av 8,10,12 1,287 Natio at Li r CIPP 2008
CSRP Harbor Are Unit 4 8 7,055 Natio at Lir r CIPP 2008
SSRP H01 Olympic Blvd 8,10 13,247 Natio at Li r CIPP 2008
SSRP H28A Willa v Gie 8 8,818 Natio at Lin r CIPP 2008
SSRP H28B Fr nklm 8,10 8,168 Na LI r CIPP 2008
SSRP H28C Su et 8,10,12,15 10,011 Natio at La CIPP 2008
SSRP 509Ime at Hwy 8,10,12 20,119 Natio at Lin CIPP 2008
SSRP H32A Canyo &Spnng 8 4,913 Natio at La CIPP 2008
SSRP H29A La at&Mulholla id 8 13,691 Natio at Li CIPP 2008
SSRP U19A Rochester Au 8 18,997 Natio at Lir CIPP 2009
SSRP U18B Verte Ay 8,10 11,075 Natio at Lin CIPP 2009
SSRP U18A Ro oma Rd 8 16.410 Natio al Lir CIPP 2009
SSRP U 24 Robertson Blvd 8,12 7,887 National Liner CIPP 2010
Total Footage Installed 453,413
LA Co nty Sanitatio Dist South Park Tr nk Suer 18 713 No apipe CIPP 2003
1755 Works Mill Road Arte Blvd Tr nk San 18 332 No apipe CIPP 2003
Whittle CA 90601 Joni Outfall"C"Unit 3F 18 490 Masterlu r CIPP 2005
Contact Rich Julio Distnct 29 Pha II 8,10,12 6,572 Mastedin r CIPP 2006
Pho (562)699-7411 xt 1607 Storm Dr Rehab at W W Pla 1t 18 540 Masterlin CIPP 2006
Belvede Trunk Sewe 10,12,15 864 Mastedin CIPP 2006
Li oln Av Trunk Sewe 8 1,305 Mastedn CIPP 2006
Weste Av Trunk Sewe 10 3,180 Masterlu r CIPP 2006
Inglewood Trunk Sewer 8,10,12,15,18 22,443 National Liner CIPP 2007
Total Footage Installed 36,439
City of Mo Lake Sewer Lin ng Project 2006 8,10,12 30,829 Natio at Lin CIPP 2006
321 South Balsam St Sewe Lir ng Project 2008 8 37,300 Riblo EX 2008
Mo Lake WA 98837
Contact Shawn 0'Bn
Pho (509)766-9217
Total Footage Installed 68,129
Goleta West Sanitary District Pha II Sewe Rehab 6 7,719 No apipe CIPP 2004
P 0 Box 4 Pha 11 Sewe Rehab 6,8,10,12,15 10,413 Riblo EX 2004
Goleta CA 93116 Pha III Sewer Rehab 6 5,212 Mastedin CIPP 2005
Contact Mark Natio Pha III Se r Rehab 6,8,10 12993 Riblo EX 2005
Phone (805)968-2617 Phase IV Sewer Rehab 6,8,10, 12,15,18 22 053 National Liner CIPP 2010
Total Footage Instated 58,390
City of Burbank City of Di rbank Sewe Rehab 8,12 36955 Riblo EX 2001
275 East Olive Au Pha 6-Rehab of EQ Da aged Sewe 8,10 3,560 Riblo EX 2002
Dl rbank,CA 91510 Sanitary Sewe Ha rd Mitigatio Prg 8,10 4,060 Riblo EX 2004
Contact Matt Rutowski
Phone (818)238-3930
Total Footage Instated 44.575
LA Co nty Dept of Public Works Ke Au 8 6,345 Riblo EX 2000
900 S Fremont Av Ford Av 8 6,677 Riblo EX 2000
Atha 'fir CA 91803 Popla Pla 8, 2 15601 Riblo EX 2001
Contact Keith Lehto 89th Str et 17268 Riblo EX 2001
Pho (626)300-3304 Lanfr St 10398 Riblo EX 2002
Contact Harry Gong 101th St 8,018 Riblo EX 2002
Pho (626)458-3157 Tnggs St 9,577 Riblo EX 2003
Servic St 17,208 Riblo EX 2003
Herbert Av 14,218 Riblo EX 2004
Ariz Av 17,658 Riblo EX 2004
Walnut Dr 12,199 Riblo EX 2005
Los Angele Riv r Side Inlets 12,18,21,2 27,30,36 3467 Natio at Li CIPP 2006
Fr st Str et 16,862 Riblo EX 2007
Flower Str et 8069 Riblo EX 2007
Hammel Sir et 9970 Riblo EX 2007
McBnde Str at 15,846 Riblo EX 2007
Ma Del Rey 8,10,12,15,18 17,242 Riblo EX 2008
Michiga Av 8 15.197 Riblo EX 2008
Clela Av 8 14,203 Riblo EX 2008
Olympic Au 8,10 9,368 Riblo EX 2008
CDR Pha IC 12,15,18,21,24,36 9092 Natio at Lin CIPP 2008
Amalia Au 8,10 10,27 Riblo EX 2008
Fishe Sir at 8 13,200 Riblo EX 2009
Do r Str et 8 23,461 Riblo EX 2009
CDR 438 Pha II 18,21,24,27,30 2,265 National Liner CIPP 2009
Total Footage Installed 303,686
City of Sa Diego Wastewate Div Sewe G up 90 6,8 5,891 Riblo EX 2003
Contact Jo Cady ROW&Ea ement Pha B 8,10 40,215 Riblo EX 2004
Pho (619)482-2076 ROW&Ea ement Pha C 6,8 61,052 Riblo EX 2006
Contact Marge et Llaga ROW&Ea ement Pha F 8 44439 Riblo EX 2009
Phon- (858)654-4494
Total Footage Instated 151,597
1(0 SO/14p
U i y
/14 9bP
oRpoitov
ADDENDUM NO. 1
Contract Documents and Construction Plans
BRISTOL STREET SEWER REPLACEMENT PHASE II
CIP PROJECT NO 129
Today's Date: September 07 2011
Bid Opening Date: October 25, 2011
This Addendum is hereby made a part of the contract documents and construction drawings. Receipt of
the Addendum shall be noted on the Bid Form. The following changes, additions, clarifications or
modifications shall be made to the contract documents and construction drawings; all other conditions
remain the same. - -
Contractor's Bid Price shall include night work if required by the City of Newport
Beach or Costa Mesa Sanitary District.
If there are any questions,please call (949) 631 1731 office or(949)468-9840 cell. Thank you.
COSTA MESA SANITARY DISTRICT
-41E-
Robin B.flamers, PE
District Engineer
i
DESIGNATION OF SUBCONTRACTORS
In compliance with the 'Subletting and Subcontracting Fair Practices Act' being Sections 4100-4113
of the Government Code of the State of California, and any amendments thereto, each bidder shall set
forth below the name and location of the place of business of each Subcontractor who will perform
work or labor or render service to the prime Contractor in or about the construction of the work or
improvement in an amount in excess of 1/2 of 1%of the prime Contractor's total bid and shall further
set forth the portion of the work which will be done by each such Subcontractor Only one
Subcontractor for each such portion shall be listed.
If the Contractor fails to specify a Subcontractor for any portion of the work to be performed undcr
the contract, he shall be deemed to have agreed to perform such work himself, and he shall not be
permitted to subcontract that portion of the work except under the conditions hereinafter set forth.
Subletting or subcontracting of any portion of the work to which no Subcontractor was designated in
the original bid, shall only be permitted in cases of public emergency or necessity and then only after a
finding reduced to writing as a public record of the Legislative Body of the owner
Portion State License
Of Work Subcontractor's Name and Address Number Class
ra4c'tc Control 5'23594 A
13241 Gareten C,rrNte Blvd
Garden Gm's et CA 9Z 84o
Ex«rva+ton etyl„ss C4nrdcs King Company 13813c. A
ZS41 Csar1dcr14 Ave
%Taal 1-1.ttl 1 CA 9o-t55
CMSD Project No. 129 Bid Proposal Form—8 of 10
10% BIDDER'S BOND TO ACCOMPANY PROPOSAL
(Required if the bidder desires to submit bond instead of a certified or cashier's check).
KNOW ALL PEOPLE BY THESE PRESENTS.
That we, RePipe-California,Inc. as principals, and
Arch Insurance Company as surety, are held and firmly bound unto the Costa
Mesa Sanitary District, a special district,organized under the laws of the State of California and situated
in Orange County in the sum of Ten Percent of Amount Bid
($ 10% ) to be paid to the District, its successors and assigns, for which payment
well and truly to be made, we bind ourselves, our heirs, executors, and administrators, successors or
assigns,joint and severally firmly by these presents.
THE CONDITION OF THIS OBLIGATION IS SUCH,
That if the certain proposal of the above bounden
RePipe-California,Inc. , is accepted by the Costa Mesa
Sanitary District, and if the above bounden, RePipe-California,Inc. _ his
heirs,executors,administrators, successors and assigns, shall duly enter into and execute a contract
for such construction, and shall execute and deliver the LABOR AND MATERIAL and the FAITHFUL
PERFORMANCE BONDS described within 10 days (not including Sunday) from the date of the
mailing of a notice of the above bounden, RePipe-California,Inc. by and from District, that said
contract is ready for execution, then this obligation shall become null and void; otherwise it shall be and
remain in full force and virtue.
IN WITNESS WHEREOF
We hereunto set our hands and seals this 21st day
of October , 2011
RePipe-California,Inc.
�,alifrarn,
7-17
FP�Rq °'
� `N^ 'co-
Arch Insurance ompany
SEAL
2002d✓c
�C Q� Jodinn Dombrowski,Attorney-in-Fact
lAWp
tr
CMSD Project No. 129 Bid Proposal Form—9 of 10
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189
r,M.M .M. etA-tz .mm M. r.M x cez.c-, zc .. . . , r, r..M.er.M. tex ce cace,M. ..F.,,,M4-
,F Aig State of Californ�iia ��� ��p I�f LI
1 County of 5 /1 I .Y 1 avcit t (o 1 LS
fi On (0 2H( before me, W l JLL 1„ceja 1, /1-0,4,1 koi(L gN
I* Date He.In ert Name nd Title of the Odic djd,S
g personally appeared Vi �� I� yt((p))j 51
Name of Sign r(sy
10 Aiq
5 who proved to me on the basis of satisfactory
fi evidence to be the person(%) whose name(%) is/arb
subscribed to the wit in instrument and acknowledged
fi to me that he/slye/thEy executed the same in
'fi his/hp/tyeir authorized capacity(i$), and that by I
YVONNE MCLELLAN his/h/r/tVir signature) on the instrument the 4
i' ' ?..- Commission di 1798268 person(�S)', or the entity upon behalf of which the
.r r:- '! Notary Public California g erson acted, executed the instrument.
%,,,;z%,;•.',/ San Bernardino County p
Comm.E res Ma 16.2012
I certify under PENALTY OF PERJURY under the
�� laws of the State of California that the foregoing
?. paragraph is true and correct.
WITNESS my hand and official seal. xii
in Signature: IiUwvl` CIA
Pla Notary Seal Ahoy Signatu of Notary Public
OPTIONAL
Though the information below is not required by law, it may prove valuable to persons relying on the document "�y
OA and could prevent fraudulent removal and reattachment of this form to another document
ig Description of Attached Document i
?? Title or Type of Document:
'�c Document Date. Number of Pages:
Z'�
Zc Signer(s) Other Than Named Above: I
• Capacity(ies) Claimed by Signer(s) i
Signer's Name: Signer's Name
5 ❑ Corporate Officer Title(s): ❑Corporate Officer—Title(s):
igc ❑ Individual RIGHT THUNEPRINT ❑ Individual RIGHT THUMBPRINT ,,,,.I
OF SIGNER OF SIGNER
❑ Partner—❑Limited ❑General Top of thumb he ❑Partner—❑Limited ❑General Top of th ,b here
g ❑ Attorney in Fact ❑Attorney in Fact i
❑ Trustee ❑Trustee
H ❑ Guardian or Conservator ❑Guardian or Conservator
g ❑ Other ❑Other
r
5' Signer Is Representing: Signer Is Representing:
el
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0 2010 Natio at Notary As alto Natio alNotary rg 1-800-US NOTARY(1-800-876-6827) Item#5907
NON-COLLUSION AFFIDAVIT
The bidders, by its officers and agents or representatives present at the time of filing this bid, being
duly sworn on their oaths say, that neither they nor any of them have in any way directly or
indirectly entered into any arrangement or agreement with any other bidder, or with any public officer
of Costa Mesa Sanitary District whereby such affiant or affiants or either of them has paid or is to pay to
such bidder or public officer any sum of money or has given or is to give to such other bidder or public
officer anything of value whatever, or such affiant or affiants or either of them has not directly or
indirectly, entered into any arrangement or agreement with any other bidder or bidder, which tends to
or does lessen or destroy free competition in the letting of the contract sought for on the attached bids,
that no bid has been accepted from any Subcontractor or supplier through any bid depository, the By-
Laws, Rules, or Regulation of which prohibit or prevent the Contractor from considering any bid from
any Subcontractor or supplier which is not processed through said bid depository or which prevent any
Subcontractor or supplier from bidding to any Contractor who does not use the facilities of or accept
bids from or through such bid depository- that no inducement of any form or character other than that
which appears upon the face of the bid will be suggested, offered, paid or delivered to any person of the
contract, nor has this bidder any agreement or understanding of any kind whatsoever, with any person
whomsoever to pay deliver to, or share with any other person in any way or manner, any of the
proceeds of the contracts sought by this bid.
Rc r ire— c4 r .
5525 E. C„brabfna- 5+
On-fart o CA. 4l7(4
Subscribed and s orn to before me by
( (>41!
This__day of 20
My Commission expires:
J2
Notary Public
CMSD Project No. 129 Bid Proposal Form— 10 of 10
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§1189
Teectrrr per..e.,r;crrrcrtra.^:crr..ceeaer. etleaceer. r e.4 h-r.�r.:cxa.e.cresr-N.^a�r,.-;aroe .ce.ceS
State of California
F County of 9):1S\ . kirKliArtart 0 YaUtt }
I: IO'V- f N6L N 9 �c-hl r e 'il
On I before me,Dale �He In ea Na 1� nd Tillelol lh flee
fi personally appeared fl/""" " 7 Y 41 A
Nametp5 of Sign qv).qv). I
fi„O
who proved to me on the basis of satisfactory g
ial evidence to be the person($ whose name($ is/�(e
subscribed to the within instrument and acknowledged
V to me that he/st2e/ttioy executed the same in
his/h91/ttOir authorized capacity(i2s), and that by
Av
yVONNE MCLELLAN his/h /t Ir signatureks, on the Instrument the
I: .. t,∎_ Commissions 1190268 person( or the entity upon behalf of which the
0 ..^ .%' Notary Public California > person(sj acted, executed the instrument.
r?if San Bernardino County ��I
4 Comm.E es Ma 16,2012f I certify under PENALTY OF PERJURY under the c4
laws of the State of California that the foregoing
gparagraph is true and correct.
I. >"1>,,
WITNESS my hand and official seal. 1
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Signature: 1
gPla Notary Seal Abov Sign] of Notary Public
� OPTIONAL
'F Though the information below is not required by law, it may prove valuable to persons relying on the document
1j and could prevent fraudulent removal and reattachment of this form to another document
I
H Description of Attached Document el
�,, Title or Type of Document: l
b I Document Date: Number of Pages:
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
0 Signer's Name: Signer's Name' yiy,,
❑ Corporate Officer—Title(s): ❑Corporate Officer—Title(s): Yik
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El Individual RIGHT THUMBPRINT
❑ Individual RIGHT THUMBPRINT
I OF SIGNER OF SIGNER
❑ Partner—❑Limited ❑General Top of thumb here ❑Partner—❑Limited ❑ General Top of m� ,b he
❑ Attorney In Fact ❑Attorney in Fact
F. ❑ Trustee ❑Trustee 'I
Ili Guardian or Conservator ❑Guardian or Conservator i
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❑ Other ❑Other
Signer Is Representing: Signer Is Representing:
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Surety Acknowledgement
State of Connecticut
County of Litchfield
On this 21 stday of October, 2011 before me personally appeared
Joann Dombrowski
To me know who being by me duly sworn did depose and say that
he/she is the
Attorney-in-Fact of
Arch Insurance Company
The Corporation described in and which executed the above
instrument; that he/she knows the seal of said Corporation and that
he/she signed his/her name thereto by like order
\�a L. Piccyr
Agjc3 NOTARY/'
O III
111 I J. 4' . • •< , My Comm.Expires
otary Public Jessica L. Piccirillo ; June 30,2015
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My Commission Expires. June 30, 2015 '`,�nannectic��.
POWER OF ATTORNEY
Know All Men By These Presents:
That the Arch Insurance Company, a corporation organized and existing under the laws of the State of Missouri, having its
principal office in Kansas City, Missouri(hereinafter referred to as the"Company")does hereby appoint
Russell M. Canterbury Joann Dombrowski, Marion R. Vail and Susan E. Deak of Farmington, CT(EACH)
its true and lawful Attomey(s)-in-Fact,to make,execute, seal, and deliver from the date of issuance of this power for and
on its behalf as surety,and as its act and deed:
Any and all bonds and undertakings
EXCEPTION: NO AUTHORITY is granted to make, execute, seal and deliver bonds or undertakings that guarantee the
payment or collection of any promissory note,check,draft or letter of credit.
This authority does not permit the same obligation to be split into two or more bonds in order to bring each such bond
within the dollar limit of authority as set forth herein.
The Company may revoke this appointment at any time.
The execution of such bonds and undertakings in pursuance of these presents shall be as binding upon the said
Company as fully and amply to all intents and purposes, as if the same had been duly executed and acknowledged by Its
regularly elected officers at its principal office in Kansas City, Missouri.
This Power of Attorney is executed by authority of resolutions adopted by unanimous consent of the Board of Directors of
the Company on March 3,2003,true and accurate copies of which are hereinafter set forth and are hereby certified to by
the Undersigned Secretary as being in full force and effect:
"VOTED, That the Chairman of the Board,the President, or any Vice President,or their appointees designated in writing
and filed with the Secretary, or the Secretary shall have the power and authority to appoint agents and attomeys-in-fact,
and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and
undertakings, recognizances, contracts of indemnity and other writings, obligatory in the nature thereof, and any such
officers of the Company may appoint agents for acceptance of process.
This Power of Attorney is signed, sealed and certified by facsimile under and by authority of the following resolution
adopted by the unanimous consent of the Board of Directors of the Company on March 3,2003:
VOTED, That the signature of the Chairman of the Board, the President, or any Vice President, or their appointees
designated in writing and filed with the Secretary, and the signature of the Secretary, the seal of the Company, and
certifications by the Secretary, may be affixed by facsimile on any power of attorney or bond executed pursuant to the
resolution adopted by the Board of Directors on March 3, 2003, and any such power so executed, sealed and certified
with respect to any bond or undertaking to which it is attached,shall continue to be valid and binding upon the Company.
00ML0013 00 03 03
Page 1 of 2 Printed in U.S.A.
In Testimony Whereof, the Company has caused this instrument to be signed and its corporate seal to be affixed by their
authorized officers,this 19th day of March ,20 09
Arch Insurance Company
Attested and Certified
r COWL \30
n {EA
Ihnad /
Martin J.Nils.',Secretary J.Mir a>r 'ete, ice - ident
STATE OF PENNSYLVANIA SS
COUNTY OF PHILADELPHIA SS
I,Brian C. Kuhn,a Notary Public,do hereby certify that Martin J. Nilsen and J. Michael Pete personally known to me to be
the same persons whose names are respectively as Secretary and Vice President of the Arch Insurance Company, a
Corporation organized and existing under the laws of the State of Missouri, subscribed to the foregoing instrument,
appeared before me this day in person and severally acknowledged that they being thereunto duly authorized signed,
sealed with the corporate seal and delivered the said instrument as the free and voluntary act of said corporation and as
their own free and voluntary acts for the uses and purposes therein set forth.
COMMUNWEAL7HOF PENNSYLVANIA —"I
NOTARIAL SEAL
Brian C.Kuhn,Notay,Public Brian C.Kuhn,Notary Public
City of Philadelphia,Philadelphia County My commission expires 12-06-2011
CERTIFICATION My commission expires December 06,loll
I,Martin J. Nilsen,Secretary of the Arch Insurance Company;do hereby certify that the attached Power of Attorney dated
March 19. 2009 on behalf of the person(s)as listed above is a true and correct copy and that the same has been
in full force and effect since the date thereof and is in full force and effect on the date of this certificate;and I do further
certify that the said J.Michael Pete,who executed the Power of Attorney as Vice President,was on the date of execution
of the attached Power of Attorney the duly elected Vice President of the Arch Insurance Company.
IN TESTIMONY WHEREOF I have hereunto subscribed my name and affixed the corpor-e --I of the Arch Insurance
Company on this 21st day of October ,20 11 /
'
Martin J. N`d.'en,Secretary
This Power of Attorney limits the acts of those named therein to the bonds and undertakings specifically named therein
and they have no authority to bind the Company except in the manner and to the extent herein stated.
PLEASE SEND ALL CLAIM INQUIRIES RELATING TO THIS BOND TO THE FOLLOWING ADDRESS:
Arch Surety
3 Parkway,Ste.1500
Philadelphia,PA 19102
-1511\1)
00M10013 00 03 03 ` 101
Page 2 of 2 Printed in V.S.A.
STATE OF CALIFORNIA
DEPARTMENT OF INSURANCE N4 08157
SAN FRANCISCO
Amended
Certificate of Authonty
THIS IS TO CERTIFY THAT Pursuant to the Insurance Code of the State of California,
Arch Insurance Company
of Missouri organized under the
laws of Missouri subject to its Articles of Incorporation or
other fundamental organizational documents is hereby authorized to transact within the State,subject to
all provisions if this Certificate,the following cla ses of insurant
Fire Marine Surety Disability Liability Workers Compensation
Common Carrier Liability Boiler and Machinery Burglary
Team and Vehicle Automobile and Aircraft
as such classes are now or may hereafter be defined in the Insurance Laws of the State of California.
THIS CERTIFICATE is expressly conditioned upon the holder hereof now and hereafter bet ig in
full compliance with all,and not in violation of my,of the applicable laws and lawful requirements nade
under authority of the laws of the State of California as long as ie'h laws or requirements are in effect
and applicable,and as such laws and requirements now are, or may hereafte he changed or ar tended.
IN WITNESS WHEREOF effective as of the 15th
day of December 2005 Ihave hereunto
set my hand and caused my official seal to be affixed this
15th day of December 2005
_ John Garamendi
In t
bait 77
By
Patricia K. Staggs
for Richard D Baum tx.mix
Chief Deputy
NOTICE:
Qua cation with the Secretary of State st he acs iplished us requ ed bt the California Corpo an Code promptly
after uance of thi Certificate ofAutho iny.Failure to do so ill be folaut of Insurance Code Section 701 nd will he
grounds for revoking th Certificate of Authority punt,nt to the convcounts made the appti an tit do and the
condo] nintned hems
URM csi .iii PGO 39391
ARCH INSURANCE COMPANY
STATEMENT OF FINANCIAL CONDITION
December 31 2010
Assets
Cash in Banks $ 89 745,338
Bonds owned 1,055,658,067
Stocks 367 171 766
Premiums in course of collection 146,978,596
Accrued interest and other assets 268,448,878
Total Assets $ 1,928,002,645
Liabilities
Reserve for losses and adjustment expenses $ 681,380,653
Reserve for unearned premiums 139,311,239
Ceded reinsurance premiums payable 92,726,263
Amounts withheld or retained by company for account of others 143,242,640
Reserve for taxes, expenses and other liabilities 255,558,983
Total Liabilities 1,312,219,778
Surplus as regards policyholders 615,782,867
Total Surplus and Liabilities $ 1,928,002,645
��
By Attest: /
Senior Vice President, Chief enior Vi �• President, Secretary
Financial Officer and Treasurer nd Gen-ral Counsel
State of New York )
SS
County of Nassau )
Thomas James Ahern and Martin John Nilsen, being duly sworn, say that they are
Senior Vice President and Chief Financial Officer and Secretary respectively of
ARCH INSURANCE COMPANY Missouri; and that the foregoing is a true and correct
statement of financial condition of said company as of December 31 2010
Subscribed and sworn to before me, this V"day of March, 2011
Notary Public
BRYAN D.KOHIBECKER
ID#2403903
NOTARY PUBLIC OF NEW JERSEY
My Commissbn E>q 1fl912016