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17-0817_AEGIS ITS, INC._Bid Forms 00 00 00—BID FORMS 1.1 Bid. Bids will be received at the City of San Juan Capistrano City Clerk's Office, 32400 Paseo Adelanto, San Juan Capistrano, California, until 2:00 p.m. on Thursday, June 22"d,2017. NAME OF BIDDER: Aegis ITS, Inc. City Clerk of the City of San Juan Capistrano 32400 Paseo Adelanto San Juan Capistrano, California 92675 The undersigned hereby declare that we have carefully examined the location of the proposed Work, and have read and examined the Contract Documents, including all plans, specifications, and all addenda, if any for the following Project: CITYWIDE PEDESTRAIN COUNTDOWN SIGNAL HEADS REPLACEMENT PROJECT CIP 15103 We hereby propose to furnish all labor, materials, equipment, tools, transportation, and services, and to discharge all duties and obligations necessary and required to perform and complete the Project, as described and in strict conformity with the Drawings, and these Specifications for TOTAL BID PRICE indicated herein. The undersigned acknowledges receipt, understanding, and full consideration of the following addenda to the Contract Documents: Addenda No.1 and 2 (signed on 6/12/17 ); Addenda No. 3 received 6/19/17 1. Attached is the required Bid Guarantee in the amount of not less than 10% of the Total Bid Price. 2. Attached is the completed Designation of Subcontractors form. 3. Attached is the fully executed Noncollusion DeclarAtion form. 4. Attached is the completed Iran Contracting Act Certification form. 5. Attached is the completed Public Works Contractor Registration Certification form. 6. Attached is the completed Contractor's Certificate Regarding Workers' Compensation form. 7. Attached is the completed Bidder Information and Experience form. 16 Addendum #2 REVIEW SCHEDULE CIP 15103 Quantity Unit Price Total ITEM Work Items (In Flourest Amount 1 Mobilization for the lump sum price of 1 LS $941.88 $941.88 Remove, Furnish and Replace 8 Existing Pedestrian Signal Heads with Countdown 2 Pedestrian Heads on La Zanja Street and 8 S320.85 $2,566.80 Camino Capistrano. Remove, Furnish and Replace 6 Existing Pedestrian Signal Heads with Countdown 3 Pedestrian Heads on Acjachema Street and 6 $320.85 $1,925.10 Camino Capistrano. Remove, Furnish and Replace 6 Existing 4 Pedestrian Signal Heads with Countdown Pedestrian Heads on Ortega Highway and fi $320.85 $1,925.10 Camino Capistrano. Remove, Furnish and Replace 4 Existing Pedestrian Signal Heads with Countdown 5 Pedestrian Heads on Camino Capistrano 4 $320.85 $1,283.40 and Verdugo Street for the lump sum price of. Remove, Furnish and Replace 8 Existing 6 Pedestrian Signal Heads with Countdown 8 $320.85 $2,566.80 Pedestrian Heads on Ortega Highway and El Camino Real. Remove, Furnish and Replace 8 Existing 7 Pedestrian Signal Heads with Countdown 8 $340.85 $2,566.80 Pedestrian Heads on Del Obispo Street and 2r Camino Capistrano. Remove, Furnish and Replace 6 Existing 8 Pedestrian Signal Heads with Countdown 6 $320.85 $1,925.10 Pedestrian Heads on Del Obispo Street and Alipaz Street Remove, Furnish and Replace 6 Existing 9 Pedestrian Signal Heads with Countdown 6 $320.85 $1,925.10 Pedestrian Heads on Del Obispo Street and Paseo Adelanto. Remove, Furnish and Replace 8 Existing 10 Pedestrian Signal Heads with Countdown 8 $320.85 Pedestrian Heads on Del Obispo Street and $2,566.80 Via Betardes. 17 Addendum #2 ITEM Work Items Quantity Unit Price Total (In Fiouresl Amount Remove, Furnish and Replace 4 Existing 11 Pedestrian Signal Heads with Countdown 4 $320.85 $1,283.40 Pedestrian Heads on Alipaz and Via Positive. Remove, Furnish and Replace 4 Existing 12 Pedestrian Signal Heads with Countdown Pedestrian Heads on Camino Del Avion and 4 $320.85 $1,283.40 Via Positive. Remove a, Furnish nd Replace 6 Existing 13 Pedestrian Signal Heads with Countdown Pedestrian Heads on Camino Capistrano 6 $320.85 $1,925.10 and Oso Road. Remove, Furnish and Replace 6 Existing 14 Pedestrian Signal Heads with Countdown Pedestrian Heads on Rancho Viejo Road 6 $320.85 $1,925.10 and Junipero Serra Road. Remove, Furnish and Replace 4 Existing 15 Pedestrian Signal Heads with Countdown Pedestrian Heads on Del Obispo Street and 4 $320.85 $1,283.40 Aguacate Road. Remove, Furnish and Replace 4 Existing 16 Pedestrian Signal Heads with Countdown Pedestrian Heads on Del Obispo Street and 4 $320.85 $1,283.40 Calle Aspero. Remove, Furnish and Replace 4 Existing 17 Pedestrian Signal Heads with Countdown Pedestrian Heads on Camino Capistrano 4 $320.85 $1,283.40 and San Juan Creek Road. i Remove, Furnish and Replace 4 Existing 18 Pedestrian Signal Heads with Countdown 4 $320.85 $1,283.40 Pedestrian Heads on Camino Capistrano and Avenida Aeropuerto. Remove, Furnish and Replace 6 Existing 19 Pedestrian Signal Heads with Countdown 6 $320.85 $1.925.10 Pedestrian Heads on Del Obispo Street and Blue Fin Drive. Remove, Furnish and Replace 2 Existing 20 Pedestrian Signal Heads with Countdown 2 $320.85 $641.70 Pedestrian Heads on Camino Capistrano and Stonehill Drive. Remove, Furnish and Replace 6 Existing 21 Pedestrian Signal Heads with Countdown 6 $320.85 $1,925.10 Pedestrian Heads on Camino Capistrano and Avenida Padre Drive. 18 Addendum#2 Quantity. Unit Price Total ITEM Work Items (In Floured Amount Remove, Furnish and Replace 6 Existing 22 Pedestrian Signal Heads with Countdown 6 $320.85 $1,925.10 Pedestrian Heads on La Novia Avenue and San Juan Creek Road. Remove, Furnish and Replace 4 Existing 23 Pedestrian Signal Heads with Countdown 4 $320.85 Pedestrian Heads on Junipero Serra Rd and $1,283.40 JSerra Hign School. Remove, Furnish and Replace 6 Existing 24 Pedestrian Signal Heads with Countdown 6 $320.85 $1,925.10 Pedestrian Heads on Camino Capistrano and Avenida Golondrina. TOTAL $41,368.98 The costs for any Work shown or required in the Contract Documents, but not specifically identified as a line item are to be included in the related line items and no additional compensation shall be due to Contractor for the performance of the Work. In case of discrepancy between the Unit Price and the Item Cost set forth for a unit basis item, the unit price shall prevail and shall be utilized as the basis for determining the lowest responsive, responsible Bidder. However, if the amount set forth as a unit price is ambiguous, unintelligible or uncertain for any cause, or is omitted, or is the same amount as the entry in the item Cost" column, then the amount set forth in the "Item Cost" column for the item shall prevail and shall be divided by the estimated quantity for the item and the'price thus obtained shall be the Unit Price. For purposes of evaluating Bids,the City will correct any apparent errors in the extension of unit prices and any apparent errors in the addition of lump sum and extended prices. The estimated quantities for Unit Price items are for purposes of comparing Bids only and the City makes no representation that the actual quantities of work performed will not vary from the estimates. Final payment shall be determined by the Engineer from measured quantities of work performed based upon the Unit Price. 19 Addendum#2 TOTAL BID PRICE: TOTAL BID PRICE BASED ON BID SCHEDULE TOTAL OF UNIT PRICES FOR CITYWIDE PEDESTRIAN COUNTDOWN SIGNAL HEADS REPLACEMENT PROJECT CIP 15103 { $41,368.98 Total Bid Price in Numbers $Forty one thousand, three hundred and sixty eight dollars and ninety eight cents Total Bid Price In Written Form In case of discrepancy between the written price and the numerical price, the written price shall prevail. MJP The undersigned agrees that this Bid Form constitutes a firm offer to the City which cannot be withdrawn for the number of calendar days indicated in the Notice Inviting Bids from and after the Bid opening, or until a Contract for the Work is fully executed by the City and a third party,whichever is earlier. The successful bidder hereby agrees to sign the contract and furnish the necessary bonds and certificates of insurance within ten (10)working days after the City provides the successful bidder with the Notice of Award. Upon receipt of the signed contract and other required documents, the contract will be executed by the City, after which the City will prepare a letter giving Contractor Notice to Proceed. The official starting date shall be the date of the Notice to Proceed, unless otherwise specified. The undersigned agrees to begin the Work within ten (1 0)working days of the date of the Notice to Proceed, unless otherwise specified. The undersigned has examined the location of the proposed work and is familiar with the Drawings and Specifications and the local conditions at the place where work is to be done. If awarded the contract, the undersigned agrees that there shall be paid by the undersigned and by all subcontractors to all laborers, workers and mechanics employed in the execution of such contract no less than the prevailing wage rate within Orange County for each craft, classification, or type of worker needed to complete the Work contemplated by this contract as established by the Director of the Department of Industrial Relations. A copy of the prevailing rate of per diem wages are on file at the City's Administration Office and shall be made available to interested parties upon request. Fidelity and Deposit Enclosed find cash, bidder's bond, or cashier's or certified check No. from the Company of Maryland Bank in the amount of 10%of the Total Bid Price ,which is not less than ten percent(10%)of this bid, payable to City of San Juan Capistrano as bid security and which is given as a guarantee that the undersigned will enter into a contract and provide the necessary bonds and certificates of insurance if awarded the Work. The bidder furthermore agrees that in case of bidder's default in executing said contract and furnishing required bonds and certificates of insurance, the cash, bidder's bond, or cashier's or certified check accompanying this proposal and the money payable thereon shall become and shall remain the property of the City of San Juan Capistrano. 20 Addendum #2 Bidder is an individual , or corporation X , or partnership , organized under the laws of the State of California . Bidder confirms license(s) required by California State Contractor's License Law for the performance of the subject project are in full effect and proper order. The following are the Bidder's applicable license number(s), with their expiration date(s)and class of license(s): 969067-Class A-General Engineering -Expiration Date: January 31, 2018 969067-Class C-10-Electrical-Expiration Date: January 31, 2018 969067-Class C-7-Low Voltage- Expiration Date: January 31, 2018 If the Bidder is a joint venture, each member of the joint venture must include the required licensing information. Sureties that will furnish the Faithful Performance Bond and the Labor and Material Payment Bond, in the form specified herein, in an amount equal to one hundred percent (100%) of the contract price within ten (10) working days from the date the City provides the successful bidder the Notice of Award. Sureties must meet all of the State of California bonding requirements, as defined in California Code of Civil Procedure Section 995.120 and must be authorized by the State of California. The insurance company or companies to provide the insurance required in the contract documents must have a Financial Strength Rating of not less than "A= and a Financial Size Category of not less than "Class VII" according to the latest Best Key Rating Guide. At the sole discretion of the City, the City may waive the Financial Strength Rating and the Financial Size Category classifications for Workers' Compensation insurance. (signatures continued on next page) . 1 21 Addendum#2 I hereby certify under penalty of perjury under the laws of the State of California that all of the information submitted in connection with this Bid and all of the representations made herein are true and correct. Executed at Anaheim, CA , on this 27th day of June , 2017 . (Bidders Name— Print or Type) Brian Akerley, Regional Manager (Name and Title) (Corporate Seal) , (Signature)) Names of individual members of firm or names and titles of all officers of corporation and their addresses are listed below: Name Michael C. Doyle Title Chairman of the Board Complete Address 3360 East La Palma Avenue, Anaheim, CA 92806 Phone (714) 575-5559 FAX (714) 630-1973 Name Douglas C. Terry Title Chief Operating Officer Complete Address 3360 East La Palma Avenue, Anaheim, CA 92806 Phone (714) 575-5701 FAX (714) 630-1973 Name Rodney Mathis Title Executive Vice President Complete Address 3360 East La Palma Avenue, Anaheim, CA 92806 Phone (714) 575-5704 FAX (714) 666-1123 Name John W. Tracey Title Chief Financial Officer Complete Address 3360 East La Palma Avenue, Anaheim, CA 92806 Phone (714) 575-5553 FAX (714) 630-1973 22 Addendum #2 1.2 Bid Bond [Note: Not required when other form of Bidder's Security, e.g. cash, certified check or cashier's check, accompanies bid.] The makers of this bond are, Aegis ITS,Inc. , as Principal, and Fidelity and Deposit Company of Maryland , as Surety and are held and firmly bound unto the City of San Juan Capistrano, hereinafter called the City, in the penal sum of TEN PERCENT (10%) OF THE TOTAL BID PRICE of the Principal submitted to CITY for the work described below, for the payment of which sum in lawful money of the United States, well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors and assigns,jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH that whereas the Principal has submitted the accompanying bid dated June 22 , 20 17 , for Citywide Pedestrian Countdown Head Replacement Project CIP 15103. If the Principal does not withdraw its Bid within the time specified in the Contract Documents; and if the Principal is awarded the Contract and provides all documents to the City as required by the Contract Documents; then this obligation shall be null and void. Otherwise, this bond will remain in full force and effect. Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Contract Documents shall in affect its obligation under this bond, and Surety does hereby waive notice of any such changes. In the event a lawsuit is brought upon this bond by the City and judgment is recovered, the Surety shall pay all litigation expenses incurred by the City in such suit, including reasonable attorneys' fees, court costs, expert witness fees and expenses. IN WITNESS WHEREOF, the above-bound parties have executed this instrument under their several seals this 14th day of June , 2017 , the name and corporate seal of each corporation. (Corporate Seal) Aegis ITS,Inc. Contractor/ Principal „ Title to'%4.4 A/I A A.%) Q-1' Fidelity and Deposit Company of Maryland (Corporate Seal) Surety By Attorney-n- act Adri.ipe. .la (Attach Attorney-in-Fact Certificate) Title Attorney-In-Fact 23 Addendum#2 Notary 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 On , 20_, before me, , Notary Public, personally appeared , who proved to me on the basis of satisfactory Name(s)of Signer(s) ` evidence to be the person(s) whose name( , i- are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in er/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s); or 4,s- entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. IA/14E S my hand and official seal. Signature of Notary Public `. OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of'this form to another document. CAPACITY eLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT ❑ Individual ❑ Corporate Officer Title(s) Tit or Type of Document s. ❑ Partner(s) ❑ Limited ❑ General Num ser of Pages ❑ Attorney-In-Fact ❑ Trustee(s) ❑ Guardian/Conservator Date of DocbTent ❑ Other: Signer is representing: Name Of Person(s)Or Entity(ies) Signer(s)Other Than Named Above NOTE: This acknowledgment is to be completed for Contractor/Principal. 24 Addendum#2 B'f345i.AlrB3i AaNtir.r.4.Y.]:f*Rir. f':Y "a.COLNFailel.*:074.1*`f IN4.1 I.M4:1.10art 4.015I,1IfIT.AZWi1:4N:f:arosk+Iem isi:Gif.[W'VVIriC IRITI:iSirt*•i:Cfil..asa.m.,,,i.rong a:[+I:`/7'oiIin,,z4:il x California All-Purpose Certificate of Acknowledgment A notary public or other officer completing this certificate verifies only the identity of the individual who signed the z document to which this certificate is attached,and not the truthfulness,accuracy, or validity of that document. H 1 State of California 4 o County of Orange s.s. x g 06/14/2017 On before me, Lisa Saumur,Notary Public ii 0 personally appeared Adriana Valenzuela who proved to me on the basis of satisfactory evidence to be the person(s)whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the g instrument. I certify under PENALTY OF PERJURY under the laws 04 of the State of California that the foregoing paragraph is true and correct. a �, LISA MARIE SAuM— A - COMM. #2146523 z :A ,,, c x WITNESS and and • I- seal. ii'_ . -- -+ Notary Public •• California o // znot Orange County al L/--n r�,( ,, t� to r nm,- s Mar. 17,2t12() �? OPTIONAL INFORMATION Description of Attached Document z The preceding Certificate of Acknowledgment is attached to aMethod of Signer Identification 14 document titled/for the purpose of P P Proved to me on the basis of satisfactory evidence: I 1 form(s)of identification r ,�credible witness(es) pages,and dated • Notarial event is detailed in notarya containingloumalon: F Page# Entry# , The signer(s)capacity or authority is/are as: 1 ❑ Individual(s) Notary contact: I ❑ Attorney-in-fact E ' ❑ Corporate Officer(s) Other ` ❑ Additional Signer ❑ Signer(s)'Thumbprints(s) 0 E5 ❑ Guardian/Conservator g ❑ Partner-Limited/General i Z. e ❑ Trustee(s) ❑ Other is representing: CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 Cc ._a�C•�i., c,�.., C,�i,,e. ,•,:. .wC . .,:�• ¢. s�4 NC . .-4 _.� c v. ,a�:S.�t a..C•c:NTC•.!:N.�<,,.-�. .t,Tt C_aQ c..�.` .t .. 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 Deo '1.c ) On 0L2 f 15I j 1 before me, &(16'at JL i('),LJ IV ,n (0Iibt i & Date Here Insert Name and Title of the Officer personally appeared a;in I -'tLL Name(s) of Signer(s) , who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s)on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. 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. WENINO# Signature ))/01-4 ,C cc COMM#2176822ALIFO a Signa ure of NotaryPublic i' - ,' NOTARY PUBLIC-CALIFORNIA z g ORANGE COUNTY My Commission Expires Jan.20,2027 2 Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: ❑Corporate Officer — Title(s): ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General El Partner — ❑ Limited ❑ General ❑ Individual [ I Attorney in Fact ❑ Individual l i Attorney in Fact ❑Trustee hi Guardian or Conservator ❑Trustee [ ] Guardian or Conservator ❑ Other: El Other: Signer Is Representing: Signer Is Representing: ©2014 National Notary Association •www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item #5907 ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS:That the ZURICH AMERICAN INSURANCE COMPANY,a corporation of the State of New York,the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY,a corporation of the State of Maryland,and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Maryland (herein collectively called the "Companies"), by GERALD F.HALEY,Vice President,in pursuance of authority granted by Article V,Section 8,of the By-Laws of said Companies,which are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate, constitute, and appoint Lourdes LANDA, Mark ROSSKOPF, Adriana VALENZUELA and Lisa SAUMUR, all of Anaheim, California, EACH its true and lawful agent and Attorney-in-Fact,to make,execute,seal and deliver,for,and on its behalf as surety,and as its act and deed: any and all bonds and undertakings,and the execution of such bonds or undertakings in pursuance of these presents,shall be as binding upon said Companies,as fully and amply,to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York,New York., the regularly elected officers of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills,Maryland.,and the regularly elected officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland.,in their own proper persons. The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V,Section 8,of the By-Laws of said Companies,and is now in force. IN WITNESS WHEREOF, the said Vice-President has hereunto subscribed his/her names and affixed the Corporate Seals of the said ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND,this 29th day of December,A.D.2016. ATTEST: ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND C tine 67j`••-._...-•:%� lv e4 BY Secretary Vice President Eric D.Barnes Gerald F.Haley State of Maryland County of Baltimore On this 29th day of December,A.D.2016,before the subscriber,a Notary Public of the State of Maryland,duly commissioned and qualified,GERALD F.HALEY,Vice President,and ERIC D.BARNES,Secretary,of the Companies,to me personally known to be the individuals and officers described in and who executed the preceding instrument,and acknowledged the execution of same,and being by me duly sworn,deposeth and saith,that he/she is the said officer of the Company aforesaid,and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies,and that the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations. IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed my Official Seal the day and year first above written. .cam Constance A.Dunn,Notary Public My Commission Expires:July 9,2019 POA-F 012-4152V 1.3 List of Subcontractors In compliance with the Subletting and Subcontracting Fair Practices Act Chapter 4 (commencing at Section 4100), Part 1, Division 2 of the Public Contract Code of the State of California and any amendments thereof, Bidder shall set forth below: (a) the name and the location of the place of business, (b)the California contractor license number, (c)the DIR public works contractor registration number, and(d)the portion of the work which will be done by each subcontractor who will perform work or tabor or render service to the Bidder in or about the construction of the work or improvement to be performed under this Contract in an amount in excess of one-half of one percent (0.5%) of the Bidder's Total Bid Price. Notwithstanding the foregoing, if the work involves the construction of streets and highways,then the Bidder shall list each subcontractor who wilt perform work or labor or render service to the Bidder in or about the work in an amount in excess of one-half of one percent(0.5%) of the Bidder's Total Bid Price or $10,000, whichever is greater. No additional time shall be granted to provide the below requested information. If a Bidder fails to specify a subcontractor or if a contractor specifies more than one subcontractor for the same portion of work, then the Bidder shall be deemed to have agreed that it is fully qualified to perform that portion of work and that it shall perform that portion itself. CSLB DIR Work to be done by Name of Location of Contractor Registration °!o of Subcontractor Subcontractor Business License No. Number Work All work will be self-performed by Aegis ITS,Inc.! 61147 02100129379545.1 CIP 15103 -27- 00 41 43-BID FORMS Work to be CSLB DIR Name of Location of Contractor Registration %of done by Subcontractor Subcontractor Business License No. Number Work I : 1 . i • . . , . 1 , 1 1 i I 4 1 i 1 1 1I i I , 1 1 , 1 i 1 1 1 I i I (Attach additional sheets if necessary) Name of Bidder Aegis ITS,Inc. Signature Name and Title Ii j(l Brian Akerley,Regional ger Dated June 27,2017 61147 02100129379545.1 CIP 15103 -28- 00 41 43-BID FORMS 1.4 Bidder Information and Experience Form ARTICLE 1. INFORMATION ABOUT BIDDER (Indicate not applicable("N/A")where appropriate.) NOTE: Where Bidder is a joint venture, pages shall be duplicated and information provided for all parties to the joint venture. 1.0 Name of Bidder: Aegis ITS, Inc. 2.0 Type,if Entity: Corporation 3.0 Bidder Address: 3360 East La Palma Avenue Anaheim, CA 92806 _ (714) 666-1123 (714) 575-5734 Facsimile Number Telephone Number bakerley@aegisits.com Email Address 4.0 How many years has Bidder's organization been in business as a Contractor? 15 years 5.0 How many years has Bidder's organization been in business under its present name? 8 years 5.1 Under what other or former names has Bidder's organization operated? Econolite Traffic Engineering&Maintenance,Inc. 6.0 If Bidder's organization is a corporation,answer the following: 6.1 Date of Incorporation: May 14,2009 (Aegis ITS,Inc,) 6.2 State of Incorporation: California 6.3 President's Name: Abbas Mohaddes 6.4 Vice-President's Name(s): Douglas C. Terry,Chief Operating Officer Rodney Mathis,Executive Vice President 6.5 Secretary's Name: Raquel Leano 6.6 Treasurer's Name: John W. Tracey, CFO 61147.02100129379545 1 CiP 15103 _29_ 00 41 43--BIO FORMS 7.0 If an individual or a partnership, answer the following: 7.1 Date of Organization: Not Applicable 7.2 Name and address of all partners(state whether general or limited partnership): 8.0 If other than a corporation or partnership, describe organization and name principals: Not Applicable 9.0 List other states in which Bidder's organization is legally qualified to do business. Alabama,Arizona,Florida,Georgia,Maryland,North Carolina,Ohio South Carolina,Texas,Virginia,Washington,and West Virginia 10.0 What type of work does the Bidder normally perform with its own forces? Maintenance and Operations(Advanced Traffic Signal Management Systems (ATMS),communications,and ITS maintenance and repair services); Communications Engineering(network and communications engineering,design and Integration);and Software Development and System Delivery 11.0 Has Bidder ever failed to complete any work awarded to it? If so, note when, where, and why: No 12.0 Within the last five years, has any officer or partner of Bidder's organization ever been an officer or partner of another organization when it failed to complete a contract?If so,attach a separate sheet of explanation: No 13.0 List Trade References: International Municipal Signal Association(ISMA) American Builders and Contractors(ABC) 6114713210029379545.1 CIP 15103 _ j_ 00 4143—BIO FORMS 14,0 List Bank References(Bank and Branch Address): Bank of the West 13300 Crossroads Parkway North City of Industry,CA 91746 15.0 Narne of Bonding Company and Name and Address of Agent: Fidelity and Deposit Company of Maryland BB&T Insurance Services of California,Inc. 2400 Katella Avenue, Suite 1100,Anaheim,CA 92806 (REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK] 51147 02100425370545i C1P 15103 -31- DD 4143-BID FORMS ARTICLE 2. LIST OF CURRENT PROJECTS(BACKLOG) [**Duplicate Page if needed for listing additional current projects."*j Project Description of Completion Date Cost of Bidder's Work Bidder's Work . City of San Juan Capistrano!Maintenance and Repair ,On-going 4$215,184.00 Annually s _ City of Santa Ana Maintenance and Repair 1Op going :$599,000.00 Annually f CiSy of Fullerton vlaintenance and Repair 10 n t•in $274,020 00 Annually of Thousand Oaks Maintenance and Repair •ngoingkity ,$278,132.29 Annually City of Eastvale Maintenance and Repair On-going 38,000.00 Annually City of Cerritos Maintenance and Repair •n-going 153,599.00 Annually i rity of Claremont Maintenance and Repair pn-going 397,177.00 Annually icity of Fontana Maintenance and Repair 'On-:oin: $135,829.00 Annuall City of Montclair Maintenance and Repair On-going $50,000.00 Annually City of La Verne ,Maintenance and Repair On-going $24 ,000.00 Annually City of Downey Maintenance and Repair On-going ,282,896.00 Annually I 61147 02100129379545.1 CIP 15103 -32- 00 41 43—BID FORMS ARTICLE 3. LIST OF COMPLETED PROJECTS—LAST THREE YEARS ("Duplicate Page if needed for listing additional completed projects.•`] Please include only those projects which are similar enough to demonstrate Bidder's ability to perform the required Work. • Project ! Description of Completion Date Cost of Bidder's Work Bidder's Work Citywide RSNS Sign $30,000-City furnished 1 City of Santa Ana Change Out June 2015 1 their own signs RSNS Sign —` ' City of Claremont Replacement f July 2016 $110,000 RSNS Sign i City of Camarillo , Replacement I December 2016 g$1.3,000 Installation of City of Westminster , Flashing Heads June 2015 $15,000 (i 1 E ° I 9 ; � . I f j 61147.021001293795451 CIP 15103 -33- 00 41 43-BID FORMS ARTICLE 4. EXPERIENCE AND TECHNICAL QUALIFICATIONS QUESTIONNAIRE Personnel: The Bidder shall identify the key personnel to be assigned to this project in a management, construction supervision or engineering capacity. 1. List each person's job title, name and percent of time to be allocated to this project: Pat Showalter- Field Maintenance Department Manager- 20% Rick Duncan-Utility Construction Department Manager-20% Dorian Pappas-Project Coordinator-50% 2. Summarize each person's specialized education: Pat Showalter-Various Electronics Certifications from Associated Technical College Rick Duncan-Construction Management Degree from Long Beach City College Dorian Pappas-Bachelor Degree from the University of La Verne 3. List each person's years of construction experience relevant to the project: Pat Showalter-21 years Rick Duncan-41 years Dorian Pappas-5 years 4.Summarize such expeience: Pat Showalter's and Rick Duncan's experience has been exclusively in the traffic signal and ITS industries characterized by public works projects ranging from traffic signal builds and maintenance,fiber optics,electrical work and ISNS&RSNS sign installation. Dorian Pappas'experience for the past 5 years has been in the public works sector.as well as characteri7ed_by sign structure and ITS installation 5. List each person who has completed 3M training in the 3M Sign Management Program and the corresponding date of training completion. If none, list person who will be trained by 3M and the proposed date of the training. Bidder agrees that personnel named in this Bid will remain on this Project until completion of ail relevant Work, unless substituted by personnel of equivalent experience and qualifications approved in advance by the City. Changes Occuring Since Prequalification 61147.02100129379545.1 GIP 15103 -35- 00 4143-BID FORMS If any substantive changes have occurred since Bidder submitted its prequalcation package for this Project, Bidder shall list them below. If none are listed, Bidder certifies that no substantive changes have occurred. No substantive changes have occurred Additional Bidder's Statements: If the Bidder feels that there is additional information which has not been included in the questionnaire above, and which would contribute to the qualification review, it may add that information in a statement here or on an attached sheet, appropriately marked: None ARTICLE 5. VERIFICATION AND EXECUTION These Bid Forms shall be executed only by a duly authorized official of the Bidder: I declare under penalty of perjury under the laws of the State of California that the foregoing information is true and correct: Name of Bidder Aegis ITS,Inc. Signature Name Brian Akerley Title Regional Manager Date June 27,2017 81147.0210=9379545.1 CIP 15103 -3,6- 00 41 43-BID FORMS 1.5 Non-Collusion Declaration The undersigned declares: I am the Regional Manager of Aegis ITS,Inc. , the party making the foregoing Bid, The Bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation. The Bid is genuine and not collusive or sham. The Bidder has not directly or indirectly induced or solicited any other Bidder to put in a false or sham bid. The Bidder has not directly or indirectly colluded, conspired, connived, or agreed with any Bidder or anyone else to put in a sham bid, or to refrain from bidding. The Bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the Bid Price of the Bidder or any other Bidder, or to fix any overhead, profit, or cost element of the Bid Price, or of that of any other Bidder. All statements contained in the Bid are true. The Bidder has not, directly or indirectly, submitted his or her Bid Price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid, and has not paid, and will not pay, any person or entity for such purpose. Any person executing this declaration on behalf of a Bidder that is a corporation, partnership, joint venture, limited liability company, limited liability partnership, or any other entity, hereby represents that he or she has full power to execute, and does execute, this declaration on behalf of the Bidder. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this declaration is executed on June 27,2017 [date], at Anaheim [city], California [state]. o Name of Bidder Aegis ITS,Inc. Signature , r__...-- 5--. , K- Name Brian Akerley Title Regional Manager 61147.02100\29379545.1 CIP 15103 -37- 00 41 43-BID FORMS 1.6 Iran Contracting Act Certification. (Public Contract Code section 2200 et seq.) As required by California Public Contract Code Section 2204, the Contractor certifies subject to penalty for perjury that the option checked below relating to the Contractor's status in regard to the Iran Contracting Act of 2010(Public Contract Code Section 2200 et seq.)is true and correct: ® The Contractor is not: (1) identified on the current list of person and entities engaged in investment activities in Iran prepared by the California Department of General Services in accordance with subdivision(b)of Public Contract Code Section 2203;or (2) a financial instruction that extends, for 45 days or more, credit in the amount of $20,000,000 or more to any other person or entity identified on the current list of persons and entities engaging in investment activities in Iran prepared by the California Department of General Services in accordance with subdivision (b) of Public Contract Code Section 2203, if that person or entity uses or will use the credit to provide goods or services in the energy sector in Iran. ❑ The City has exempted the Contractor from the requirements of the Iran Contracting Act of 2010 after making a public finding that, absent the exemption, the City will be unable to obtain the goods and/or services to be provided pursuant to the Contract. ❑ The amount of the Contract payable to the Contractor for the Project does not exceed$1,000,000. Signature: • I Printed Name: Brian Akerley Title: Regional Manager Firm Name: Aegis ITS,Inc. Date: June 27,2017 Note: In accordance with Public Contract Code Section 2205, false certification of this form shall be reported to the California Attorney General and may result in civil penalties equal to the greater of$250,000 or twice the Contract amount,termination of the Contract and/or ineligibility to bid on contracts for three years. 61147.02100129379545.1 CIP15103 -38- 00 4143-BID FORMS 1.7 Public Works Contractor Registration Certification Pursuant to Labor Code sections 1725.5 and 1771.1, all contractors and subcontractors that wish to bid on, be listed in a bid proposal,or enter into a contract to perform public work must be registered with the Department of Industrial Relations. See httn://www.dir.ca.gov/Public- Works/PublicWorks.html for additional information. No bid will be accepted nor any contract entered into without proof of the contractor's and subcontractors' current registration with the Department of Industrial Relations to perform public work. Bidder hereby certifies that it is aware of the registration requirements set forth in Labor Code sections 1725.5 and 1771.1 and is currently registered as a contractor with the Department of Industrial Relations. Name of Bidder. Aegis ITS,Inc. DIR Registration Number: 1000010720 DIR Registration Expiration: June 30,2018 Bidder further acknowledges: 1. Bidder shall maintain a current DIR registration for the duration of the project. 2. Bidder shall include the requirements of Labor Code sections 1725.5 and 1771.1 in its contract with subcontractors and ensure that all subcontractors are registered at the time of bid opening and maintain registration status for the duration of the project. 3. Failure to submit this form or comply with any of the above requirements may result in a finding that the bid is non-responsive. Name of Bidder Aegis ITS,Inc. Signature Name and Title Brian Akerley,Regional Manager Dated June 27,2017 61147.02100129379545.1 QIP15103 -39- 00 4143-BID FORMS 1.8 Contractor's Certificate Regarding Workers' Compensation. I am aware of the provisions of section 3700 of the Labor Code which require every employer to be insured against liability for workers' compensation or to undertake self-insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the performance of the work of this Contract. Name of Bidder Ae:is ITS,Inc. Signature AI Name Brian Akerle / Title Regional Manager Dated June 27, 2017 s 61147.02100\29379545.1 CIP 15103 40- 00 41 43-BID FORMS