ATTACHMENT 5 BID/BIDDER CERTIFICATION SHEET · $ ~On ob $ 'i' Do. oo $ 1?06.00 $ ,,,-oo.Do $150.tJO $ l)D. DD ... 42 2 Per Each System Full Installation of Terminal System, Buried

ATTACHMENT 5 BID/BIDDER CERTIFICATION SHEET

Invitation For Bid IFB Number 03A2746

Page I of 2

On ly an individual who is authorized to bind the bidding firm contractually shall sign the Bid/ Bidder Certification Sheet. The s ignature must indicate the title or posi tion that the individual holds in the firm. This Bid/ Bidder Certificat ion Sheet must be s igned and returned along with all "required attachments" as an entire package with o riginal s ignatures. The bid must be transmitted in a sealed envelope in accordance with IFB instructions.

A . Our all-inclusive bid is submitted in a sealed envelope marked " Bid Submittal - Do Not Open" . B. A ll required attachments are included with this certification sheet. C. I have read and un derstand the DVBE participation require ments and have included documentation

demonstrating that I have met the participation goals. D. The s ignature affixed hereon and dated certifies compliance w ith a ll the req uirements of this bid document. The

s ignature be low authorizes the verificat ion of this certification . E. The signature and date affixed hereon certifies that th is bid is a firm offer for a 90-day period .

An Unsigned Bid/Bidder Certification Sheet May Be Cause for Bid Rejection

I . Company Name

---v v (_,

3. Address

1 001~ Indicate your organization type:

2a. Fax Number

OJ()) 7y3.q3~7_

4. ole Proprietorship 5. 0 Partnership 6. 0 Corporation

Jndicate the applicable employee and/or corporation number: 7. Federal Employee ID No. (FEIN) {o'3 - D-3 3 (..' g Q / I 8. California Corporation No.

Ind icate the Department of Industrial Re lations information: 9. Contractor Registration Number f 0 0000 55 ~'-/ Indicate applicable license and/or ce1tification information: 10. Contractor's State Licensing

Board Number

14. Signature

11. PUC License Number CAL-T-

13. Title

Ow 1)-e v 15. Date

__, . 2$.Zb/8 16. Are you certified with the Department of General Services, Office of Small Business and Disabled Veteran Business Enterprise Services (OSDS) as : \/-, a. Small Business Enterprise Yes ,t::J No 0 b. Disabled Veteran Business Enterprise Yes 0 N~ If yes, enter certification number: If yes, enter your service code below:

<6._2-1 b NOTE: A copy of your Certification is required to be included ifeither of the above items is checked "Yes".

Date application was submi tted to OSDS, if an application is pending:

17. Are you a Non-Small Business committing to the use of 25% Certified Small Business Subcontractor Participation? Yes 0 No~

If Yes, complete and return the Bidder Declaration form, GSPD-05-1 05 with your bid.

STATE OF CALIFORNIA- DEPARTMENT OF TRANSPORTATION BID PROPOSAL

REVISED ATTACHMENT 1 (2/23/18)

CONTRACTOR'S NAME (Please Print): ~V 01 V\ IL /l{ ~ J 111,""" ITEM ESTIMATED UNIT OF

ITEM NO. QUANTITY MEASURE

1 1250 Per Linear Foot Reconstruct metal beam guardrail (MSGR), single sided, wood post

2 1250 Per Linear Foot Reconstruct metal beam guardrail (MBGR), double sided, wood post

3 1250

Per Linear Foot Reconstruct metal beam guardrail (MSGR), single sided, steel post

4 1250 Per Linear Foot Reconstruct metal beam guardrail (MBGR), double sided, steel post

5 1250 Per Linear Foot Reconstruct Midwest guardrail (MGS), single sided, wood post

6 1250 Per Linear Foot Reconstruct Midwest guardrail (MGS), double sided, wood post

7 1250 Per Linear Foot Reconstruct Midwest guardrail (MGS), single sided, steel post

8 1250 Per Linear Foot Reconstruct Midwest guardrail (MGS), double sided, steel post

9 1250

Per Linear Foot Reconstruct metal beam guardrail (MSGR), double sided, wood post with channel

1250 Reconstruct metal beam guardrail (MBGR), double sided, steel post 10 Per Linear Foot with channel

11 1250 Per Linear Foot Reconstruct thrie beam barrier, single s ided, wood post

12 1250 Per Linear Foot Reconstruct thrie beam barrier, single sided, steel post

13 1250 Per Linear Foot Reconstruct thrie beam barrier, double sided, wood post

14 1250 Per Linear Foot Reconstruct thrie beam barrier, double sided, steel post

15 1 Per Linear Foot Partial installation ofTerminal System, SRT 350 (27" Wood Post)

16 1 Per Linear Foot Partial installation of Terminal System, SRT 350 (27" Steel Post)

17 1 Per Linear Foot Partial installation of Terminal System, SRT 350 (31 " Steel Post)

18 1 Per Linear Foot Partial Installation of Terminal System, CAT 350

19 1 Per Linear Foot Partial Installation of Terminal System, SKT 350 (Wood Post)

IFB NUMBER 03A2746 Page 1 of5

CONTRACT NO.

UNIT PRICE TOTAL (In Figures) (In Figures)

$ / 00 60 $ /7;;, oor>.15{)

$ 120.00 $ I

15tJ1000.06 $ I o<t. co $

/Jj, MfJ. 6D

$//5 (;{) $ I

/ l/_;i,. 75/), t> () $ q?i,DO $Jli 7 :)() .1>0

$/60.llfl $ I

'/ZS, /JOO,~D

$ /1 0. DD $ I

'/J7 jM,t()

$ /l/6, DO $ I

'J 1S /bl). OD

$I OD. OD $ . . J 2 !Ji IJfJD.IYD

$ / 2D· ()() $ . /S!J, /)/JO, ~D

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$ /L/Q .O 0 $ / 7?, {)()() I p "l>

$ /lO,Dt> $ I

/~b, ()~{). D 7)

$ I'-{ f> .DD $ / 7S 60{).oD

$ looo. no $ loOO. no $ ( On.oo $ lDO.oD $ ~On ob $ 'i' Do. oo $ 1?06 .00 $ ,,,-oo.Do $150.tJO $ l)D. DD

(1) THE ABOVE QUANTITIES ARE ESTIMATES ONLY AND ARE GIVEN AS A BASIS FOR COMPARISON OF BIDS. NO GUARANTEE IS MADE OR IM PLIED AS TO THE EXACT QUANTITY THAT WILL BE NEEDED.

(2) IN CASE OF DISCREPANCY BETWEEN THE UNIT PRICE AND THE TOTAL SET FORTH FOR A UNIT BASIS ITEM, THE UNIT PRICE SHALL PREVAIL. (3) ANY ALTERATIONS, MODIFICATIONS OR CHANGES TO THIS BID PROPOSAL SHEET BY THE PROPOSER SHALL BE GROUNDS FOR BID REJECTION. (4) EACH LINE MUST BE BID. PLEASE DO NOT LEAVE ANY UNIT PRICE COLUMN BLANK OR THIS BID WILL BE DISQUALIFIED FROM COMPETITION FOR CONTRACT AWARD. (5) CONTRACTOR'S COSTS FOR ALL LABOR, M ATERIALS, TOOLS, PARTS, INCIDENTALS, TRAVEL, EQUIPMENT, AND INCIDENTALS NECESSARY SHALL BE INCLUDED IN THE

CONTRACTOR'S BID RATE FOR EACH ITEM LISTED IN THIS ATTACHMENT 1, BID PROPOSAL.

STATE OF CALIFORNIA - DEPARTMENT OF TRANSPORTATION BID PROPOSAL


20 1 Per Linear Foot Partial Installation of Terminal System, SKT 350 (Steel Post)

21 1 Per Linear Foot Partial Installation ofTerminal System, FLEAT 350 (Wood Post)

22 1 Per Linear Foot Partial Insta llation of Terminal System, X-Lite Guardrail Terminal (Wood Post\

23 1 Per Linear Foot Partial Installation of Terminal System, X-Lite Guardrail Terminal (Steel Post\ Partial Installation of Terminal System, X-Tension Guardrail Terminal 24 1 Per Linear Foot (Wood Post) Partial Installation of Terminal System, X-Tension Guardrail Terminal 25 1 Per Linear Foot (Steel Post)

26 1 Per Linear Foot Partial Installation of Terminal System, Buried Post Anchor

27 1000 Each Replace Block (wood)

28 1000 Each Replace Block (composite)

29 1000 Each Replace Post and Block (wood)

30 1000 Each Replace Post (Steel) and Block (composite)

31 2 Per Each System Full Installation ofTerminal System, SRT 350 (27" Wood Post)

32 2 Per Each System Full Installation of Terminal System, SRT 350 (27" Steel Post)

33 2 Per Each System Full Installation of Terminal System, SRT 350 (31 " Steel Post)

34 2 Per Each System Full Installation ofTerminal System, CAT 350

35 2 Per Each System Full Insta llation of Terminal System, SKT, 350 (Wood Post)

36 2 Per Each System Fu ll Installation of Terminal System, SKT 350 (Steel Post)

37 2 Per Each System Full Installation of Terminal System FLEAT 350 (Wood Post)

2 Full Installation of Terminal System, X-Lite Guardrail Terminal (Wood 38 Per Each System Post) 2 Full Installation ofTerminal System, X-Lite Guardrail Terminal (Steel 39 Per Each System Post)

40 2

Per Each System Full Installation of Terminal System, X-Tension Guardrail Terminal (Wood Post)

2 Full Installation of Terminal System, X-Tension Guardrail Terminal 41 Per Each System (Steel Post)


$ </, ()() () () $ <l 6D o D $ (ooo. {)() $ /(lDfl16ll

$ (.Qoo.oo $ (r.{)(). 6 D

$ Ll Oh 60 $I lt)() /)() I '

$3,·100.00 $ 3 /on.oo I I

$ 3 70(). 6() $ 3 1 1 ()(), U> _!

$ S tJO.DO $ 5 {,1{), {j v $ z_o. OD $ 20, 0()/), /JD

$ 22 · bO $ 2 2 1 Dt>l>.~V

$So, DD $ 5'6, 000. t>D

$ lo() , /){') $ 'lo (J J /)() 15. ()0

$ /,?.I)(), DD $ 7, L/oo.oo $ I ()()(),/JD $ 2, ON) ,lJD

$ j ZOO, oD $ 2, l/D0.~0 '

$ 3,50(),tJ() $ 7 cMO, ()0

$ ,,,()dd)6 $ 3,00D, 6"li I

$ z, ooOJJD $ lj DrJ "6· l>~

$ I. 2()0,0D $7, yoo,oo '

$ J .J~0106 $ 3 ~OD-60 I

$ I. 1 tJ{J. () () $3. ~(J(J ,/)"(>

$3,70(),6(> $ 7 t/bb.6D I

$ 3/iOD.DD $ 7 I () b IJ' /JO

(1) THE ABOVE QUANTITIES ARE ESTIMATES ONLY AND ARE GIVEN AS A BASIS FOR COMPARISON OF BIDS. NO GUARANTEE IS MADE OR IMPLIED AS TO THE EXACT QUANTITY THAT WILL BE NEEDED.

(2) IN CASE OF DISCREPANCY BETWEEN THE UNIT PRICE AND THE TOTAL SET FORTH FOR A UNIT BASIS ITEM, THE UNIT PRICE SHALL PREVAIL. (3) ANY ALTERATIONS, MODIFICATIONS OR CHANGES TO THIS BID PROPOSAL SHEET BY THE PROPOSER SHALL BE GROUNDS FOR BID REJECTION. (4) EACH LINE MUST BE BID. PLEASE DO NOT LEAVE ANY UNIT PRICE COLUMN BLANK OR THIS BID WILL BE DISQUALIFIED FROM COMPETITION FOR CONTRACT AWARD. (5) CONTRACTOR'S COSTS FOR ALL LABOR, MATERIALS, TOOLS, PARTS, INCIDENTALS, TRAVEL, EQUIPMENT, AND INCIDENTALS NECESSARY SHALL BE INCLUDED IN TH E

CONTRACTOR'S BID RATE FOR EACH ITEM LISTED IN THIS ATTACHMENT 1, BID PROPOSAL.

ST ATE OF CALIFORNIA - DEPARTMENT OF TRANSPORTATION BID PROPOSAL


42 2 Per Each System Full Installation of Terminal System, Buried Post End Anchor

43 2 per module Replace ADIEM module

44 2 per each system Full installation of ADIEM system

45 2 Per Each System Full Installation of Compressor Attenuator Unit

46 2 Per Each System Full Installation of REACT 350 - (60")

47 2 Per Each System Full Installation of REACT 350 - (96")

48 2 Per Each System Full Insta llation of REACT 350- (120")

49 2 Per Each System Full Installation of REACT - 350 4 CYL



52 2 Per Each System Full Installation Terminal System, SoftStop

53 2 Per Each System Full Installation ofTerminal System, X-MAS (Steel Post)

54 2 Per Each System Instal l Crash Cushion System Universal TAU-II Model 30T 1070FBC

55 2 Per Each System Install Crash Cushion System Universal TAU-II Model 72T1 00WBC

56 2 Per Each System Install Crash Cushion SystemTrinity TRACC

57 2 Per Each System Install Crash Cushion SystemTrinity SHORTRACC

58 2 Per Each System Install Crash Cushion SystemTrinity FASTRACC

59 2 Per Each System Full Installation SCl-70GM (24")



62 2

Per Each System Full Installation SCl-70GM (60")


IFB NUMBER 03A2746 Page 3 ofS

$ 350,Db $(DD. DO $

I , I D61D6 $ 2 ,L;b{), 1)-0

$ 7,Z,. Mfl, Db

$ ' l/l/, MD, no

$ rt, crnn. ti -o $ 17. ioo.l)o $ ro, 000,D'b

I

$ )Do, ODD- 0 D I I

$03 /)(>{),DD $ /7,b, DfJ(J , Db , $ 1 I O/Jfi . OD $ /Lf1 1 Df)b, bD

$ 31: ooo,otJ $ foZ1DoDJYO

$ 37, ooo. t11:> $ 71/,0M. tJD '

$ lfl.DObh6 $1/2, DOD IM> $ . 3.oooJJ'6

$ . &,ODD. 6--o

$ ~SDO,bD $ J 3 {)tin. 6-0

$ $ I

' }3,000,60 ZfR, DO~, /JV

$JO, OM,DD $ f20,DOO, CO

$ /$", DD l>, D 6 $ JD, Doo. l>D

$ JD ODO. (JD $ Z0,0()p, /JO

$ -- D (,'.>DD . l> $ JS' fJDD, DD

$ 21 ooo, f;() $

l/L, DDD, ?O $

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$ I

l/ /p c 01> 1 'i)'b

$ $ 7-'-/, on1i:~D Ys. o o {) .D1)

$ -;,,, non.1;0 ~2 DOt. .oV

(1) THE ABOVE QUANTITIES ARE ESTIMATES ONLY AND ARE GIVEN AS A BASIS FOR COMPARISON OF BIDS. NO GUARANTEE IS MADE OR IMPLIED AS TO TH E EXACT QUANTITY THAT WILL BE NEEDED.

(2) IN CASE OF DISCREPANCY BETWEEN THE UNIT PRICE AND THE TOTAL SET FORTH FOR A UNIT BASIS ITEM, THE UNIT PRICE SHALL PREVAIL. (3) ANY ALTERATIONS, MODIFICATIONS OR CHANGES TO THIS BID PROPOSAL SHEET BY THE PROPOSER SHALL BE GROUNDS FOR BID REJECTION. (4) EACH LINE MUST BE BID. PLEASE DO NOT LEAVE ANY UNIT PRICE COLUMN BLANK OR THIS BID WILL BE DISQUALIFIED FROM COMPETITION FOR CONTRACT AWARD. (5) CONTRACTOR'S COSTS FOR ALL LABOR, MATERIALS, TOOLS, PARTS, INCIDENTALS, TRAVEL, EQUIPMENT, AND INCIDENTALS NECESSARY SHALL BE INCLUDED IN THE

CONTRACTOR'S BID RATE FOR EACH ITEM LISTED IN TH IS ATTACHMENT 1, BID PROPOSAL.

STATE OF CALIFORNIA- DEPARTMENT OF TRANSPORTATION BID PROPOSAL

REVISED ATTACHMENT 1 (2/2J/18)








71 2 Per Each System Full Installation QUADGUARD System 3bay

72 2 Per Each System Full Installation QUADGUARD System 6bay

73 2 Per Each System Full Installation QUADGUARD Elite System Wide 11-Bay

74 2 Per Each System Full Installation QUADGUARD Elite 8-bay System

75 2 Per Each System Full Installation QUADGUARD, LMC System11 -bay

76 2 Per Each System Full Insta llation QUADGUARD, 10 Degree System 6 bay

77 2 Per Each System Full Installation QUADGUARD 69-90 6 bay

78 2 Per Each System Full Installation QUADGUARD 69-90 11 bay

79 2 Per Each System Full Installation QUADGUARD 69-90 Tapered

80 2 Per Each System Full Installation QUADGUARD II 2 bay

81 2 Per Each System Full Installation QUADGUARD II 5 bay

82 2 Per Each System Full Installation QUADGUARD M10 (TL-3) 24 inch





$ '~o i)f'IA Ob

$ foO,DDD,riT>

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$ 3o .D!J{) , D'D $ I

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12 . ~f>D. bO $ I

•'fni./ /)(J(J,"IJV

$ J~. bOo,6D $ ·77 vlJl'i, 7> D

$ ' Jg, DD~,Ob

$ , '71p, 'f)llA, n-D

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$ /n,DDIJ1~6 $ Zo, Mo, l -o . I

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I

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$ Zl/,001>, oo $ i.f f{, 060. DD

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$ ZfR. {)(JO I oc $ 52, tJ{)().{)(>

$2Jp, D()(J, b<> $ 52, f)[)(},[)6

$ }O, COD, bD $ f12D1 MD, ti>


(2) IN CASE OF DISCREPANCY BETWEEN THE UNIT PRICE AND THE TOTAL SET FORTH FOR A UN IT BASIS ITEM, THE UNIT PRICE SHALL PREVAIL.

(3) ANY ALTERATIONS, MODIFICATIONS OR CHANGES TO THIS BID PROPOSAL SHEET BY THE PROPOSER SHALL BE GROUNDS FOR BID REJECTION. (4) EACH LINE MUST BE BID. PLEASE DO NOT LEAVE ANY UNIT PRICE COLUMN BLANK OR THIS BID WILL BE DISQUALIFIED FROM COMPETITION FOR CONTRACT AWARD. (5) CONTRACTOR'S COSTS FOR ALL LABOR, MATERIALS, TOOLS, PARTS, INCIDENTALS, TRAVEL, EQUIPMENT, AND INCIDENTALS NECESSARY SHALL BE INCLUDED IN THE

CONTRACTOR'S BID RATE FOR EACH ITEM LISTED IN THIS ATIACHMENT 1, BID PROPOSAL.

ST ATE OF CALIFORNIA - DEPARTMENT OF TRANSPORTATION BID PROPOSAL

REVISED ATTACHMENT I (2/23/18)

86 1 Each Terminal Anchor Assembly SFT

87 1 Each Terminal Anchor Assembly Type A (Breakaway Cable Anchor Assembly)

88 1 Each Terminal Anchor Assembly Type B

89 1 Each Type STB

90 100 Each Replace Soil Tubes and Plate Assembly (SRT, ET)

91 100 Each Replace Strut (Yoke)

92 2 Each Sand Barrel Array "U14", Approach 100 km/hr or Less (A81A)

93 2 Each Sand Barrel Array "U11 ", Approach 70 km/hr or Less (A81A)

94 2 Each Sand Barrel Array "U21 ", Approach 100 km/hr or Less (A81A)

95 2 Each Sand Barrel Array "U16", Approach 70 km/hr or Less

96 2 Each Sand Barrel Array "B14" Approach 100 km/hr or Less (A81A)

97 2 Each Sand Barrel Array "B11 " Approach 70 km/hr or Less (A 81C)

98 500 Per Cubic Yard Embankment Widening for End Treatment

99 500 Per Linear Foot Dike Removal and Replaced with Type C Asphalt Dike

100 500 Per Linear Foot Dike Removal and Replaced with Type F Asphalt Dike

101 1000 Per Hour Lane Closure (conventional, two-lane highway)

102 1000 Per Hour Lane Closure (multilane highway)

103 1000 Per Hour Shoulder Closure

104 500 Per Hour Ramp Closure

105 500 Per Hour Pilot Car

106 1000 Per Hour Portable Changeable Message Sign

IFB NUMBER 03A2746 Page 5 ofS

$ <t5h ob $g6o,oo

$ /,ZOD, DD $ J, l/J61DD $ I/) l>/JttiD $ J ,5DtJJ bf> $ qoo.oD $ q ob ,/)() $ I 1 I f'.I\ 60 $ / z. o, ooo, on $ 100.()t) I

$ 7 0, O{JO.bD

$ goo. oo $I , lPDD· 06 $ 801>,DD $ I /pf)fl1iJt>

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$ <jt;(), 66 $ 7 bM06 ,tl 'D '

$ f 25'. !JD $ hz 15'Ptf, NJ

$ Z/; 0,'()0 $ ~~(j),Ol)

TOTAL THIS PROPOSAL $ 7 Lfti, q t0,~ II

71 '-/6fr:; Cf D t>, 6 O


(2) IN CASE OF DISCREPANCY BETWEEN THE UNIT PRICE AND THE TOTAL SET FORTH FOR A UNIT BASIS ITEM, THE UNIT PRICE SHALL PREVAIL. (3) ANY ALTERATIONS, MODIFICATIONS OR CHANGES TO THIS BID PROPOSAL SHEET BY THE PROPOSER SHALL BE GROUNDS FOR BID REJECTION. (4) EACH LINE MUST BE BID. PLEASE DO NOT LEAVE ANY UNIT PRICE COLUMN BLANK OR THIS BID WILL BE DISQUALIFIED FROM COMPETITION FOR CONTRACT AWARD. (S) CONTRACTOR'S COSTS FOR ALL LABOR, MATERIALS, TOOLS, PARTS, INCIDENTALS, TRAVEL, EQUIPMENT, AND INCIDENTALS NECESSARY SHALL BE INCLUDED IN THE

CONTRACTOR'S BID RATE FOR EACH ITEM LISTED IN THIS ATIACHMENT 1, BID PROPOSAL.

State of California-Department of General Services, Procurement Division GSPD--05-105 (EST 8/05) ATTACHMENT 2

BIDDER DECLARATION

1. Prime bidder information (Review attached Bidder Declaration Instructions prior to completion of this form):

Invitation for Bid IFB Number 03A2746

a. Identify current California certification (s) (MB,(s~SB/NVSA, DVBE): <6i1 () or None_ (lf "None': go to Item #2)

b. Will subcontractors be used for this contract?~ {LNo _(If yes, ind icate the distinct element of work your firm will perform in this contract e.g., list the proposed products produced by your firm, state if your firm owns the transportation vehicles that will deliver the products to the State, id.entity which solicited services your firm w~perform , etc.). Use additional sheets, as necessary. _

€ c 0 fl5-/ 1/ '" L1.L. + )vi 13 {1 f2.. J~ e ( () J7 5f YUL f- f )/I e & /' C?. /\ I /::Jv.. r r 1-e r l Ti·15 it; I I £. {/( I I 6r Cl \1 i I ··~-·- , +ejl';~lj I ~ L.i~LYJS - - - --- ~~

c. If you are a California certified DVBE: {1) Are you a broker or agent? Yes _ No v (2) If the contract includes equipment rental, does your company own ,at least 51 % of the equipment provided in this contract (quantity and value)? Yes _ No _ N/A _J_

2. If no subcontractors will be used, skip to certification below. Otherwise, list all subcontractors for this contract. (Attach additional pages if necessary):

Subcontractor Name, Contact Person, Subcontractor Address CA Certification V\brk performed or goods provided Corresponding Good 51% Phone Number & Fax Number & Email Address (MB, SB, DVBE or None) for this contract % of bid price Standing? Rental?

i<o I I /) f2o c.. k . Co l'l?-1. 55 2- I '/y!A Gk ll, /!{{(µ.., /75' 07yS L ane 51)DtA Id r, y,,,5 -VA /3 d rJ /J f G JIU / -e

I

!>,.... JL{f 5/J45fa cu J~~l'YlJ° Clc5 vtre, I Lf.3 §36. q z 5". /'{ O(/ 9fft~/ 7="o c1 2 s. Ol/S-0

Vv//11 roclo"'c. i> ndv. c DI>\

CERTIFICATION: By signing the bid response, I certify under penalty of perjury that the information provided is true and correct. Page_1 _ of _ 2_

8/17/2017 Supplier Profile

Printed on: 8/17/2017 12:31:08 PM

To verify most current certification status go to: https://www.caleprocure.ca.gov

iJGS GF.NEi-<1\L SERVICES

. ..

Office of Small Business & DVBE Services

Certification ID: 8270

Legal Business Name:

FRANK MEDINA

Doing Business As (OBA) Name 1:

FRANK MEDINA GENERAL ENGINEERING

CONTRACTOR

Doing Business As (OBA) Name 2:

Address:

10096'AHART RD

OROVILLE

CA 95966-9691

Certification Type

SB( Micro)

Status

Approved

Email Address:

[email protected]

Business Web Page:

Business Phone Number:

530/7 43-07 44

Business Fax Number:

530/7 43-9352

Business Types:

Construction

From .

08/1"1/2017

To

08/31 /20 ·1 9

Stay informed! KEEP YOUR CERTIFICATION PROFILE UPDATED! -LOG IN at CaleProcure.CA.GOV

Questions? Email: [email protected]

Call OSDS Main Number: 916-375-4940 707 3rd Street, 1-400, West Sacramento, CA 95605

https://caleprocure.ca.gov/pages/SupplierProfile/supplier-profile-print.htn1I

STATE OF CALIFORNIA- DEPARTMENT OF GENERAL SERVICES PROCUREMENT DIVISION

DISABLED VETERAN BUSINESS ENTERPRISE DECLARATIONS STD. 843 (Rev. 5/2006) Instructions: The disabled veteran (DV) owner(s) and DV manager(s) of the Disabled Veteran Business Enterprise (DVBE) must complete this declaration when a DVBE contractor or subcontractor will provide materials, supplies, services or equipment [Military and Veterans Code Section 999.2]. Violations are misdemeanors and punishable by imprisonment or fine and violators are liable for civil penalties. All signatures are made under penalty of perjury.

SECTION 1

Name of certified DVBE: Roll' n Rock Construction Inc

Description (materials/supplies/services/equipment proposed):

Solicitation/Contract Number: _,0"3"'A"'2-'-74"-6"-----------

SECTION2

DVBE Ref. Number: ~1~7~5~0-'-74~5~---

Traffic Control

SCPRS Ref. Number:._=======.,..,--(FOR STATE USE ONLY)

APPLIES TO ALL DVBEs. Check only~ box in Section 2 and provide original signatures.

0 I (we) declare that the DVBE is not a broker or agent, as defined in Military and Veterans Code Section 999.2 (b), of materials, supplies, services or equipment listed above. Also, complete Section 3 below if renting equipment.

D Pursuant to Military and Veterans Code Section 999.2 (f), I (we) declare that the DVBE is a broker or agent for the principal(s) listed below or on an attached sheet(s). (Pursuant to Military and Veterans Code 999.2 (e), State funds expended for equipment rented from equipment brokers pursuant to contracts awarded under this section shall not be credited toward the 3-percent DVBE participation goal.)

All DV owners and managers of the DVBE (attach additional pages with sufficient si~nature blocks for each peraon to sign):

Bonnie Heile (Printed Name of DV Owner/Manager)

(Printed Name of DV Owner/Manager)

Firm/Principal for whom the DVBE is acting as a broker or agent: (If more than one finn, list on extra sheets.)

Firm/Principal Phone: Address:

SECTION 3

~~- z/2.0/18 (Signature of DV owner/ Manager) (Date Signed)

(Signature of DV Owner/Manager) (Date Signed)

(Print or Type Name)

APPLIES TO ALL DVBEs THAT RENT EQUIPMENT AND DECLARE THE DVBE IS NOT A BROKER.

D Pursuant to Military and Veterans Code Section 999.2 (c), (d) and (g), I am (we are) the DV(s) with at least 51% ownership of the DVBE, or a DV manager(s) of the DVBE. The DVBE maintains certification requirements in accordance with Military and Veterans Code Section 999 et. seq.

D The undersigned owner(s) own(s) at least 51 % of the guantity and value of each piece of equipment that will be rented for use in the contract identified above. I (we), the DV owners of the equipment, have submitted to the administering agency my (our) personal federal tax return(s) at time of certification and annually thereafter as defined in Military and Veterans Code 999.2, subsections (c) and (g). Failure by the disabled veteran equipment owner(s) to submit their personal federal tax retum(s) to the administering agency as defined in Military and Veterans Code 999.2, subsections (c) and (g), will result in the DVBE being deemed an equipment broker.

Disabled Veteran Owner(s) of the DVBE (attach additional pages with signature blocks for each peraon to sign):

(Pnnted Name) (Signature) (Date Signed)

(Address of owner) (Telephone) (Tax Identification Number of owner)

Disabled Veteran Manager(s) of the DVBE (attach additional pages with sufficient signature blocks for each peraon to sign):

(Pnnted Name of DV Manager) (signature of DV Manager) (Date Signed)

Page _of_

Attachement 11 STATE OF CALIFORNIA- DEPARTMENT OF GENERAL SERVICES PROCUREMENT DIVISION DISABLED VETERAN BUSINESS ENTERPRISE DECLARATIONS STD. 843 (Rev. 5/2006)


Instructions: The disabled veteran (DV) owner(s) and DV manager(s) of the Disabled Veteran Business Enterprise (DVBE) must complete this declaration when a DVBE contractor or subcontractor will provide materials, supplies, seivices or equipment [Military and Veterans Code Section 999.2]. Violations are misdemeanors and punishable by imprisonment or fine and violators are liable for civil penalties. All signatures are made under penalty of perjury.

SECTION 1

Name of certified DVBE: _____________ DVBE Reference Number:

Description (materials/supplies/seivices/equipment proposed):

Solicitation/Contract Number: SCPRS Reference Number: ~----------~

FOR STATE USE ONL SECTION 2

APPLIES TO ALL DVBEs. Check only .Q!lll box in Section 2 and provide original signatures.

D I (we) declare that the DVBE is not a broker or agent, as defined in Military and Veterans Code Section 999.2 (b), of materials, supplies, seivices or equipment listed above. Also, complete section 3 below if renting equipment.

D Pursuant to Military and Veterans Code Section 999.2 (f), I (we) declare that the DVBE is a broker or agent for the principal(s) listed below or on an attached sheet(s). (Pursuant to Military and Veterans Code 999.2 (e), State funds expended for equ;pment rented from equipment brokers pursuant to contracts awarded under this section shall not be credited toward the 3-percent DVBE participation goal.)

All DV owners and managers of the DVBE (attach additional pages with sufficient signature blocks for each person to sign):



Firm/Principal for whom the DVBE is acting as a broker or agent: (If more than one firm, list on extra sheets.)

Firm/Principal Phone: Address: ~--------

SECTION3

{Signature of DV Owner/Manager) (Date Signed)

(Signature of DV Owner/Manager) (Date Signed)

(Print or Type Name)

APPLIES TO ALL DVBEs THAT RENT EQUIPMENT AND DECLARE THE DVBE IS NOT A BROKER.

D Pursuant to Military and Veterans Code Section 999.2 (c), (d) and (g), I am (we are) the DV(s) with at least 51% ownership of the DVBE, or a DV manager(s) of the DVBE. The DVBE maintains certification requirements in acoordance with Military and Veterans Code Section 999 et. Seq

D The undersigned owner(s) ownlsl at least 51 % of the quantity and value of each piece of eauipment that will be rented for use in the contract identified above. I (we), the DV owners of the equipment, have submitted to the administering agency my (our) personal federal tax return(s) at time of certification and annually thereafter as defined In Military and Veterans Code 999.2, subsections (c) and (g). Failure by the disabled veteran equipment owner(s) to sl/bmit their personal federal tax return(s) to the administering agency as defined in Military and Veterans Code 999.2, subsections (c) and (g), will result in the DVBE being deemed an equipment broker.

Disabled Veteran Owner(s) of the DVBE (attach additional pages with signature blocks for each person to sign):

(Printed Name) (Signature) (Date Signed)

(Address of Owner) (Telephone) (Tax Identification Number of Owner)

Disabled Veteran Manager(s) of the DVBE (attach additional pages with sufficient signature blocks for each person to sign):

(Printed Name of DV Manager) (Signature of DV Manager) (Date Signed)

Page__[_ of .L

ATTACHMENT 12 Invitation for Bid No. 03A27 46

QUOTES FROM SB OR DVBE SUBCONTRACTORS


Page I of I

Bidder shall attach copies of SB OR DVBE SUBCONTRACTORS quotes (on SB or DVBE's letterhead) from any SB or DVBE subcontractors listed in the fonn GSPD-05-105. Refer to instructions in IFB Section D), Items I C and 2 A 2).

Roll 'N Rock Construction Inc. 5527 Truck Village Drive

Mount Shasta, CA 96067 License# 971838 A, C61/D49 & C31 TRAFFIC CONTROL

MB/DVBE # 1750745 N DIR# 1000013621

SIGNATORY TO LABORERS UNION #324

DATE: 2/20/18 TO: General Contractors ATTN: Estimators

Contract Number: 03A2746

Item# 2 Construction Area Signs {Furnish, Install, and Remove) );;> Stationa ry CAS Contact us for CAS prices );;> Funding Signs );;> Motorist/Traffic Hand ling/ Speed Reduction/ ETC. signs upon request );;> $800 fee fo r USA locations of signs );;> Traffic contro l excluded );;> These prices are va lid even if Roll'n Rock does not provide traffic control

Item #3 Traffic Control {T-13) );;> 8Hr. shift with 2 flaggers );;> 8Hr. sh ift extra flagger (if needed) );;> Overtime rate per hr. );;> Sundays and holidays rate per hr. );;> No additional charges for night work

Item #3 Traffic Control {T-13)

Email: rol [email protected]

Phone: (530) 925-1408 Fax: (530) 926-0450

Price: N/A Price: N/A

Price: $1,350.00 Price: $650.00 Price: $100.00 Price: $110.00

);;> Quoted rates include all cones and advanced wa rning signs as needed. Any additiona l signage shall be provided by the prime contractor or rented from Roll 'N Rock. Rate sheet available upon request

Item #3 Pilot Car (T-13) );;> 8Hr. sh ift pilot car w ith drive r );;> Overtime pilot ca r w ith driver, per hr. );;> Sundays and holid_~ys- rate per hr.

' Item #4 Portable Changeable Message Board

);;> Message Board: o Per Day $300.00 Per Week $600.00 Per Month $1,200.00

);;> Message Board Delivery: o Rate: $95.00. hr. port to port if Roll 'N Rock provides Traffic Control

Item #3 Rumble Strips

o Per Day $300.00 Per Week $700.00 Per Month $1,400.00

Price: $800.00 Price: $105.00 Price: $120.00

ACKNOWLEDGEMENT & AGREEMENT: BY APPOINTING OR LISTING ROLL 'N ROCK CONSTRUCTION INC. AS A

SUBCONTRACTOR ON THIS PROJECT, THE PRIME CONTRACTOR ACKNOWLEDGES AND AGREES TO ALL APPLICABLE

TERMS AND CONDITIONS DESCRIBED ON PAGE 3 OF THIS PROPOSAL. THESE TERMS & CONDITIONS ARE BINDING AND

MUST BE INCLUDED IN EACH EXECUTED SUBCONTRACT AGREEMENT MADE BETWEEN YOUR FIRM AND ROLL 'N ROCK

CONSTRUCTION INC.

Page 1 of 4

Roll 'N Rock Construction Inc.

Item #3 Lane/Shoulder/Ramp Closure 2 Miles (T-10, T-11 and T-14)

»- 8Hr. shift with 1 TC person, cone truck and 1 arrow board »- 8Hr. shift w ith 2 TC persons, cone truck and 1 arrow board »- 8Hr. shift extra TC person (if needed) »- Overtime rate per TC person per hr. (truck included) »- Sundays and holidays rate per hr. );>- No additional charges for night work

Item #3 Additional Closures - Same Crew (T-10, T-11 and T-14)

»- Additional lane closure/opposite direction (includes arrow board) »- Additional ramp closure »- Additional detour (6 signs or less)

Item #3 Traffic Control (T-10, T-11 and T-14)

Price: 1,450.00

Price: $650.00

Price: $100.00

Price: $110.00

Price: $250.00

Price: $250.00

Price: $250.00

»- Quoted rates include all cones and advanced warning signs as needed, up to 2 miles. Any additional signage shal l be provided by the prime contractor or rented from Roll 'N Rock. Rate sheet available upon request

Item #3 Attenuator Truck

»- Attenuator Truck:

o Per Day $600.00 Per Week Sl,600.00 Per Month $4,000.00 o Fuel not included in rental rate o 8 hr. sh ift with operator o Overtime rate w ith operator per hr.

»- Attenuator Truck-Delivery:

o Rate : $100.00 hr. port to port if Roll 'N Rock provides Traffic Control

Price: $950.00

Price: $125.00

ACKNOWLEDGEMENT & AGREEMENT: BY APPOINTING OR LISTING ROLL 'N ROCK CONSTRUCTION INC. AS A SUBCONTRACTOR ON THIS PROJECT, THE PRIME CONTRACTOR ACKNOWLEDGES AND AGREES TO ALL APPLICABLE TERMS AND CONDITIONS DESCRIBED ON PAGE 3 OF THIS PROPOSAL. THESE TERMS & CONDITIONS ARE BINDING AND MUST BE INCLUDED IN EACH EXECUTED SUBCONTRACT AGREEMENT MADE BETWEEN YOUR FIRM AND ROLL 'N ROCK CONSTRUCTION INC.

Respectfully Submitted by,

Bonnie Heile President I CEO

Roll'n Rock Construction Inc.

Page 2 of4


Extra Items bidding

Item# Description Quantity Price Total

-

I

These prices are only valid if Roll'n Rock provides traffic control

ACKNOWLEDGEMENT & AGREEMENT: BY APPOINTING QR LISTING ROLL 'N ROCK CONSTRUCTION INC. AS A

SUBCONTRACTOR ON THIS PROJECT, THE PRIME CONTRACTOR 1 ACKNOWLEDGES AND AGREES TO ALL APPLICABLE

TERMS AND CONDITIONS DESCRIBED ON PAGE 3 OF THIS PROPOSAL. THESE TERMS & CONDITIONS ARE BINDING AND

MUST BE INCLUDED IN EACH EXECUTED SUBCONTRACT AGREEMENT MADE BETWEEN YOUR FIRM AND ROLL 'N ROCK

CONSTRUCTION INC.

Respectfully Su bmitted by,

Bonnie Hei le

President I CEO

Roll'n Rock Construction Inc. "

Page 3 of 4


TERMS AND CONDITIONS

Acknowledgement & Agreement : By appointing or listing Roll 'N Rock Construction Inc. as a subcontractor on this project, the Prime Contractor acknowledges and agrees to all applicable terms and conditions as stated within the quoted prices and in the descriptions provided below.

Unless otherwise agreed to in writing, prior t o the time of bid acceptance, no items shall be amended or excluded from this subcontract.

Roll 'N Rock Construction Inc. requires this executed subcontract agreement prior to t he start of any work and requires at least 10 calendar days advance notice for mobilization of PCMS, arrow boards, light towers, attenuator trucks, flaggers, pilot cars, etc.

If less than 3 consecutive shifts are performed, an additional $500.00 will apply, per occurrence.

Roll 'N Rock Construction Inc. is Union, signatory to the Laborers Traffic Control/Highway Improvement Agreement of Northern California. Roll 'N Rock Construction Inc. is bound to the terms and conditions set forth by the Northern California District Council of Laborers of the Laborers International Union of North America.

Quoted rates do not include .5 (half) hour lunch required if not relieved by the Prime Contractor.

Where applicable, add $27.50 per day per person for subsistence.

Prime Cont ractor is responsible for furnishing flag persons with breaks. Prime Contractor agrees to provide up to 10 minutes per Roll 'N Rock Construction Inc. employee for relief break periods, as needed, due to weather and heat conditions to meet CAL/OSHA heat illness prevention requirements. If this condition cannot be met by the Prime Contractor, Roll 'N Rock Construction Inc. will hire an additional man at the Prime Contractor's expense.

Any shift where traffic control services are performed for less than 8 hours will be billed for the entire 8 hours and will not be prorated.

Cancellations made in less than 24 hours of the requested show up time will be charged at 50% of quoted rates, based on an 8 hour sh ift.

Equipment: Our pilot car and flaggers will be equipped with VHF and UHF 2-way radios and with CB radios for communication with your truckers and other CB-equipped equipment.

The Prime Contractor shall be responsible for any damage or loss to/of any equipment (PCMSs, Arrow Boards, Lighting Towers, Attenuator Trucks, Rumble Strips, etc.) due to traffic conflicts, vandalism, theft, acts of nature and/or mishandling by Prime Contractor's staff, this includes batteries. Prime Contractor is responsible for all lost, stolen, or damaged equipment on job site (includes all powered and non-powered equipment). A daily record of items used will be provided by Roll 'N Rock Construction Inc. for the Prime Contractor to sign off on. Additional signs requi red due to damage, theft, or plan inadequacies will be billed as extra work.

Fuel expense for an attenuator truck and light tower will be billed to the Prime Contractor at the rate of $5.00 per gallon.

For safety of the public, contractors and employees of Roll 'N Rock Construction Inc., t raffic control duties shall not be performed during hours of darkness without light towers. It is the responsibil ity and expense of the Prime Contractor to furnish light towers.

Insurance: Roll 'N Rock Construction Inc. maintains insurance coverages as requi red by USDOT-Caltrans (Commercial General Liability, Commercial Auto, and Worker's Compensation).

Payments: Roll 'N Rock Construction Inc. will bil l weekly. Invoice is due and payable 30 days from t he date of t he invoice. Customer/Prime Contractor agrees to pay a finance charge of 1.5% per month on all past due balances. Customer/Prime Contractor further agrees to pay reasonable attorney's fees and cost if collection is required. Prime Contractor is to provide monthly progress payments for all complet ed work. Monthly payments must be received in full by Roll 'N Rock Const ruction Inc. to avoid finance charges and/ or collection fees. There will be no retention held on Traffic Control.

Good Faith Conduct: If there are any issues or concerns regarding Roll 'N Rock Construction Inc. and its employees, products, or work performed, the Prime Contractor shall promptly notify and give Roll 'N Rock Construction Inc. first opportunity to correct such problems. We look forward to working with you and are committed to safety on the job and good faith in all aspects.

Should you have any questions regarding these terms, please contact us directly.

I hereby accept all t erms and conditions of this proposal and t hat t his proposal w ill be incorporated into all contract agreements.

Signature: ______ , ________ _ Printed Name: ______________ _ Dat e: _ _ _ _ _ _

On Behalf of (Company Name): _______________ _ Position/Title: _ _ ____________ _

Page4of 4

Documents

ATTACHMENT 5 BID/BIDDER CERTIFICATION SHEET · $ ~On ob $ 'i' Do. oo $ 1?06.00 $ ,,,-oo.Do $150.tJO $ l)D. DD ... 42 2 Per Each System Full Installation of Terminal System, Buried