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PW Public Safety Center Demolition00 43 93 - BID SUBMITTAL CHECKLIST 1.1 BID INFORMATION A. Bidder: CVE Contracting Group Inc. dba Central Valley Environmental B. Prime Contract: C. Project Name: City of San Rafael Essential Facilities Demolition Project— Public Safety Center D. Project Location: 1309 5w Avenue, San Rafael, CA 94901 E. Owner: City of San Rafael, F. Architect: Mary McGrath Architects H. Construction Manager: Kitchell 1.2 BIDDER'S CHECKLIST A. In an effort to assist the Bidder in properly completing all documentation required, the following checklist is provided for the Bidder's convenience. The Bidder is solely responsible for verifying compliance with bid submittal requirements. B. Attach this completed checklist to the outside of the Submittal envelope. ® Used the Bid Form provided in the ProjectManual section 00 41 13. Prepared the Bid Form as required by the Instructions to Bidders. Indicate on the Bid Form any Addenda received. [ren Bidder Registration and Safety Experience Form u Verified that the Bidder can provide Certificates of Insurance in the amounts indicated. [V] Safety Experience Form ® Non -Collusion Affidavit ® Bidders Certifications [y� Base Bid Breakdown EZ Proposed Subcontractors List 00 43 36 Attached to the Bid Form: Bid Bond OR a certified check for the amount required. Bid envelope shows name and address of the Bidder.' Bid. envelope shows the Bidder's Contractor's License Number. Bid envelope shows name of Project being bid. ® Bid envelope shows name of Prime Contract being bid, if applicable. ® Bid envelope shows time and day of Bid Opening. Bond Accompaning Bid Section 00 4313. -END OF SECTION - City of San Rafael BID SUBMITTAL CHECKLIST 00 43 93 -1 of 1 Essential Facilities Demolition Project - Public Safety Center 00 41 13 - BID FORM To be submitted as part of bid by the time and date specified in Section 00 21 13 (Instructions to Bidders), paragraph 1. CITY OF SAN RAFAEL, ESSENTIAL FACILITIES DEMOLITION PROJECT— PUBLIC SAFETY CENTER THIS BID IS SUBMITTED BY: CVE Contracting Group Inc. dba Central Valley Environmental (Firm/Company Name) Re: CITY OF SAN RAFAEL, ESSENTIAL FACILITIES DEMOLITION PROJECT— PUBLIC SAFETY CENTER The undersigned Bidder proposes and agrees, if this Bid is accepted, to enter into an agreement with the City of San Rafael for the City of San Rafael, Essential Facilities Demolition Project — Public Safety Center (Project) in the form included in the Contract Documents, Section 00 52 13 (Agreement), to perform and furnish all Work as specified or indicated in the Contract Documents for the Contract Sum and within the Contract Time indicated in this Bid and in accordance with all other terms and conditions of the Contract Documents. 2. Bidder accepts all of the terms and conditions of the Contract Documents, Section 00 11 16 (Invitation to Bids), and Section 00 21 13 (Instructions to Bidders), including, without limitation, those dealing with the disposition of Bid Security. This Bid will remain subject to acceptance for 90 Days after the day of Bid opening. 3. In submitting this Bid, Bidder represents: (a) Bidder has examined all of the Contract Documents and the following Addenda (receipt of all of which is hereby acknowledged). (b) Bidder has visited the Site and performed tasks, reviews, examinations, and analysis and given notices, regarding the Project and the Site, as set forth in Section 00 52 13 (Agreement), Article 5. (c) Bidder has received and examined copies of the geotechnical data, existing conditions and hazardous material surveys listed in Section 00 31 00. (d) Bidder has given City of San Rafael notice of all conflicts, errors, ambiguities, or discrepancies that it has discovered in or among the Contract Documents, geotechnical City of San Rafael BID FORM 00 41 13 - 1 of 4 Essential Facilities Demolition Project - Public Safety Center data, existing conditions and hazardous material surveys, and actual conditions. The written resolution thereof through Addenda issued by City of San Rafael is acceptable to Contractor. 4. Based on the foregoing, Bidder proposes and agrees to fully perform the Work within the time stated and in strict accordance with the Contract Documents for the following sums of money listed in the following Schedule of Bid Prices: SCHEDULE OF BID PRICES All Bid items must be filled in completely. Section 01 10 00 (Summary of Work) describes the scope of work to be performed under this contract. Section 0127 00 (Unit Price) describes the scope of work to establish unit prices. Quote in figures only, unless words are specifically requested. Bid Prices: ITEM DESCRIPTION 1. Base Bid: All Work for the Public Safety Center per the contract documents. Grand Total Base Bid Price: Grand Total Base Bid Price: DESCRIPTION BID PRICE G1 31�►000 ov (Words) BID PRICE ITEM 1. Alternate No. 1: Second ,n) Story Patio Double Doors fG�� to be salvaged at FS 51 2. Alternate No. 2 — 20 wood frame double hung windows to be salvaged at Blue House 3. Alternate No. 3-2400 square feet of wood lap siding to be salvaged at the Blue House 4. Alternate No. 4 —Vintage Doors Interior/ Exterior to be salvaged at the Blue House ,15'060 5. The low bidder will be determined by the Grand Total Base Bid Price for the Demolition of the Public Safety Center Alternate pricing will be presented to the San Rafael City Council at the time of contract approval. City of San Rafael City Council will determine which of the alternates (if any) they will select and add to the Project. City of San Rafael BID FORM 0041 13 - 2 of 4 Essential Facilities Demolition Project - Public Safety Center Unit Price No. 1 (Backfill for all 2 -sites) per section 01 27 00 $ 1 � Cubic Yard Unit Price No. 2 (Excavation and Off -haul for all 2 -sites) per section 0127 00 $�'7Cubic Yard Unit Price No. 3 (Import Fill for all 2 -sites) per section 0127 00 F/Thousand -leUbic Yard Unit Price No. 4 (Dewatering) per section 0127 00 $ f ' Gallons 6. The undersigned Bidder understands that City of San Rafael reserves the right to reject this Bid. The undersigned Bidder acknowledges that City of San Rafael reserves the right to include any or none of the alternates in the contract. 7. If written notice of the acceptance of this Bid, hereinafter referred to as Notice of Award, is mailed or delivered to the undersigned Bidder within the time described in paragraph 2 of this Section 00 41 13 or at any other time thereafter before it is withdrawn, the undersigned Bidder will execute and deliver the documents required by Section 00 21 13 (Instructions to Bidders) within the times specified therein. These documents include, but are not limited to, Section 00 52 13 (Agreement), Section 00 61 13 (Construction Performance Bond), and Section 00 61 16 (Construction Labor and Material Payment Bond). 8. Notice of Award or request for additional information may be addressed to the undersigned Bidder at the address set forth below. 9. The undersigned Bidder herewith encloses cash, a cashier's check, or certified check of or on a responsible bank in the United States, or a corporate surety bond furnished by a surety authorized to do a surety business in the State of California, in form specified in Section 00 21 13 (Instructions to Bidders), in the amount of ten percent (10%) of the Total Bid Price and made payable to "City of San Rafael". 10. The undersigned Bidder agrees to commence Work under the Contract Documents on the date established in Section 00 52 13 (Agreement) and to complete all work within the time specified in Section 00 52 13 (Agreement). The undersigned Bidder acknowledges that City of San Rafael has reserved the right to delay or modify the commencement date. The undersigned Bidder further acknowledges City of San Rafael has reserved the right to perform independent work at the Site, the extent of such work may not be determined until after the opening of the Bids, and that the undersigned Bidder will be required to cooperate with such other work in accordance with the requirements of the Contract Documents. 11. The undersigned Bidder agrees that, in accordance with Section 00 72 13 (General Conditions) and Section 00 73 00 (Supplementary Conditions), liquidated damages for failure to complete all Work in the Contract within the time specified shall be as set forth in Section 00 52 13 (Agreement). 12. The names of all persons interested in the foregoing Bid as principals are: (IMPORTANT NOTICE: If Bidder or other interested person is a corporation, give the legal name of corporation, state where incorporated, and names of president and secretary thereof; if a partnership, give name of the firm and names of all individual co-partners composing the firm; if Bidder or other interested person is an individual, give first and last names in full). NAME OF BIDDER: CVE Contracting Group Inc. dba Central Valley Environmental Licensed in accordance with the act for the registration of Contractors, and with DIR Number: 1000001553 License Number: 913083 Expiration: 04/30/2018 City of San Rafael BID FORM 0041 13 - 3 of 4 Essential Facilities Demolition Project - Public Safety Center Where Incorporated, if applicable California Tim Williamson, President Principals I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Sil ature of Bidder NOTE: If Bidder is a corporation, set forth the legal name of the corporation together with the signature of the officer or officers authorized to sign contracts on behalf of the corporation. If Bidder is a partnership, set forth the name of the firm together with the signature of the partner or partners authorized to sign contracts on behalf of the partnership. Business Address: Officers authorized to sign contracts: Telephone Number(s): Fax Number(s): E -Mail address: Federal ID Number: Date of Bid: 4263 N. Selland Ave. Fresno, CA 93722 Tim Williamson - President Tiffany Farlev - Corporate Secretary 559-222-1122 559-222-1147 timw@cvecorp.com, tiffanyf@cvecorp.com 45-4137958 07/25/2017 -END OF SECTION - City of San Rafael BID FORM 0041 13 - 4 of 4 Essential Facilities Demolition Project - Public Safety Center 00 43 13 - BOND ACCOMPANYING BID KNOW ALL BY THESE PRESET a Contracting Group, Inc. That the undersigned rdba Central Valley EnvironmeltAls Principal and the undersigned as Surety are held and finely bound unto City of SAN RAFAEL ( City of San Rafael), as oblige, In the penal sum of r Ten Percent of Amount Bid ) Dollars IS 0% of Bid I lawful money of the United States of America be' at least ten percent (10%) of the aggregate amount of said Principal r**SEE BELOW'* I's base Bid plus accepted Alternates, for the payment of which, well and truly to be made, we bind ourselves, our successors, executors, administrators, and assigns, jointly and severally, firmly by these presents. WHEREAS, the said Principal Is submitting a Bid for, CITY of SAN RAFAEL, ESSENTIAL FACILITIES DEMOLITION PROJECT- PUBLIC SAFETY CENTER (Project). THE CONDITION OF THIS OBLIGATION IS SUCH that if the Bid submitted by the said Principal be accepted and the Contract be awarded to said Principal and said Principal shall within the required periods enter into the Contract so awarded and provide the required Construction'Performance Bond, Construction Labor and Material Payment Bond, Insurance certificates, and all other endorsements, fomes, and documents required under Section 002113 (instructions to Bidders), then this obligation for the Bid Bond shall be void, otherwise to remain in full force and effect. IN WITNESS WHEREOF, the above bound parties have executed this instrument this f 14th 1 day of r lulv 1, 2017. (Corporate Seat) CVE Contracting Group, Inc. db rth Valle environmental By Principal Travelers Casualty and Surety Company of America Surety (Corporate Seat) BY kvL_111 Cody Lyman 16,�, Alorney in Fact -END OF SECTION- **CVE Contracting Group, Inc. dba Central Valley Environmental** City of San Rafael BOND ACCOMPANYING BID 00 43 13 - 1 of 1 Essential Facilities Demolition Project— Public Safety Center CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT Civil Code § 1189 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 ) ss County of Fresno ) On -7//,/ ho/ -7- . before me, Bonnie Gonzalez, Notary Public, personally appeared Codv Lvman , who proved to me on the basis of satisfactory evidence to be the persona) whose name(4 is/aFe subscribed to the within instrument and acknowledged to me that he/&keA4ey executed the same in his/4e4theif authorized capacity(ie4, and that by his/herAhe*F signature s} on the instrument the person(4, or the entity upon behalf of which the person(4 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. BONNIE GONZALEZ NOTARY PUBLIC • CALIFORNIA 3 m COMMISSION M 2202238 �E • .x FRESNO COUNTY My Comm. EXP. July 12, 2021 Signature. (Seal) Bonnie donzalez, Notary Public CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 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 Calif (� ) County of ! " � ;zn J l� PcbOn -Z% before me,�1� Date I e @rt Name no T' of the Offi er personally appeared ' \ C4 Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(k whose name} is/a)ir subscribed to the within instrumeVt and acknowledged t e that he/se/tFf�4i executed the same in his/hKt/tKir authorized capacity(n and that kLy his/$ter/VrW signature( n thb instrument the person - or a entity upon behalf of whic t e person acted, executed the in ument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. TIFFANY L. FARLEY WITdatur)j hand and official seal. Commission M 2139413 a • Notary Puolic •California _ ` Fresno County Sig jPAA MY Comm. Expires Jan 7, 2020 I ignature Notary Public 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: Signer(s) Other Than Named Above: Capacity(les) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Number of Pages: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: POWER OF ATTORNEY `TRAVELERS` Farmington Casualty Company St. Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters, Inc. Travelers Casualty and Surety Company of America St. Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St. Paul Guardian Insurance Company ARorney-In Fact No. Certificate No. 006955647 227966 KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company, SL Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, SL Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company are corporations duly organized under the laws of the State of Connecticut, that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa, and that Fidelity and Guaranty Insurance Underwriters, Inc., is a corporation duly organized under the laws of the State of Wisconsin (herein collectively called the "Companies"), and that the Companies do hereby make, constitute and appoint John C. Day, Steven P. Edwards, Lyn Genito, Bonnie Gonzalez, and Cody Lyman of the City o' Fresno _ _ , State of California , thew true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above, to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF, the Companies have caused this instrument to be signed and their corporate seals to be hereto affixed, this 25th day of August 2016 Farmington Casualty Company Fidelity and Guaranty; Insurance Company Fidelity and Guaranty Insurance Underwriters, Inc. St. Paul Fire and Marine Insurance Company St. Paul Guardian Insurance Company St. Paul Mercury Insurance Company Travelers Casualty and Surety Company Travelers Casually and Surety Company of America United States Fidelity and Guaranty Company G/.SU.rYA y,..iY <y Oy \OK..�NSG /Cy HSUO� PFY AMO �,1YI..� ? _yppqL �`. O ty ,✓m,' 6 OSPOgAI i W/ '_ 04 p 9 4� r`� nCNnrrca4rro £ aF' .., nr fcoNPOPn>�:,�5` 1982 0 •- - �1 avMm�J> $` 1977 1951 a n�o SEA. -%IS ;n` `x" S �e tees wxxA°' p r nM T�' �R�NCF Sq AM�a� ,�'Nvn ....'Ndo �F . �AY7 AINSr" State of Connecticut City of Hartford ss. Robert L. Raney, Senior Vice President On this the 25th day of August 2016 before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, SL Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. p,TET In Witness Whereof, I hereunto set my hand and official sealk1QT*AH My Commission expires the 30th day of June, 2021. * p(reblp i c 4Ar fid` 58440-5-16 Printed in U.S.A. WARNING: THIS POWER OF ATTORNEY Marie C. Tetreault, Notary Public 00 43 16 - WORK TO BE PERFORMED BY BIDDER Each Bidder shall provide complete and accurate information in the form below regarding the portions of the work which the Bidder intends to complete with its own forces. The failure of any Bidder to provide complete and accurate information in the following form may render the Bid Proposal of such Bidder to be nonresponsive and rejected. This Page of the Bid proposal may be reproduced as necessary to identify all portion of the Work which the Bidder intends to perform with its own forces. Portion of Work to be Performed by the Dollar Value of Portion of Work to be Performed Bidder's Own Forces by the Bidder's Own Forces (Describe by reference to Plan Sheets or Specifications Sections; Limit Information on Each Line to Discrete Portions of the Work) ©t &VU tro �0 ev It oa0vv d �� ov Zee, dDD°% Name of Bidder �r5` �a\J l/pAyyGy�1 awl -END OF SECTION - City of San Rafael WORK TO BE PERFORMED BY BIDDER 00 43 16 - 1 of 1 Essential Facilities Demolition Project— Public Safety Center 00 43 36 - PROPOSED SUBCONTRACTORS LIST Bidder submits the following information as to the subcontractors Bidder intends to employ if awarded the Contract. Pursuant to California Public Contracting Code, Section 4100 at. seq., the following list gives the name, business address, and portion of work (description of work to be done) for each subcontractor that will be used in the work if the bidder is awarded the Contract. (Additional supporting data may be attached to this page.) Each page shall be sequentially numbered, and headed "Proposed Subcontractors" and shall be signed. 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 the improvement, or a subcontractor licensed by the State of California who, under subcontract of the prime contractor, specially fabricates and installs portions of the work or improvements according to detailed drawings contained in the plans and specifications in an amount in excess of one-half of one percent (0.5%) of the general contractor's total bid. Contractor will not be permitted to change this listing without prior written approval of the Owner. If the bidder fails to stipulate a subcontractor for any portion of the work under this contract, it shall be understood that the Contractor will perform such work without subcontracting the same, and they will not be permitted to subcontract said work without prior written approval of the Owner. Contractor will be required to show a sample of the proposed subcontract to the owner prior to executing any subcontracts. The Owner will require that each subcontract have a provision where the subcontractor is assignable to the Owner. The percentage of work, labor, or services which will be done or rendered by each subcontractor shall be provided by the Contractor Full Name of Subcontractor, Address Description of Work: Subcontractor's License and Telephone Number Reference To Bid Items No. CVE Demolition Inc. Demolition and Removal of Debris 905631 905631 35500 Ss. W�eltVj Road, ern is}}} CA 95385 >rort f ` 1 JB 76 7z&!SN VleChi- iI - City of San Rafael PROPOSED SUBCONTRACTORS LIST Essential Facilities Demolition Project— Public Safety Center 0148346r �X>(2w,of�00(� Vvr �a.�t7 (Mat 004336-1 oft i (Bidder to attach additional sheets if necessary) -END OF SECTION - City of San Rafael PROPOSED SUBCONTRACTORS LIST 00 43 36 - 2 of 2 Essential Facilities Demolition Project — Public Safety Center CERTIFICATION OF PREVAILING WAGE RATES AND RECORDS By my signature hereunder, as CONTRACTOR, I certify, that I am aware of the provisions of Section 1773 of the Labor Code which requires the payment of prevailing wage on public projects. Also, that the CONTRACTOR and any subcontractors under the Contractor shall comply with Section 1776, regarding wage records, and with Section 1777.5, regarding the employment and training of apprentices, of the Labor Code. It is the CONTRACTOR'S responsibility to ensure compliance by any and all subcontractors performing work under this Contract. The information below applies to the above five sections. BIDOER'S SIGNATURE Name of Bidder CVE Contracting Group Inc. dba Central Valley Environmental Signed by (printed) Tim Williamson Title President Dated 0712512017 -END OF SECTION - City of San Rafael BIDDER CERTIFICATIONS 0045 30 - 2 of 2 Essential Facilities Demolition Project— Public Safety Center 00 45 30 BIDDER CERTIFICATIONS TO BE EXECUTED BY ALL BIDDERS ANDSUBMITTED WITH BID CERTIFICATE OF NON-DISCRIMINATION On behalf of the bidder making this Bid, the undersigned certifies that there will be no discrimination in employment with regard to race, color, religion, sex, sexual orientation, disability or national origin; that all federal, state, and local directives and executive orders regarding non-discrimination in employment will be complied with; and that the principle of equal opportunity in employment will be demonstrated positively and aggressively. BIDrWR'S SIGNATURE STATEMENT OF CONVICTIONS "I hereby swear, under penalty of perjury, that no more than one final, un -appealable finding of contempt of court by a Federal Court has been issued against me within the past two years because of failure to comply with an order of a Federal Court to comply with an order of the National Labor Relations Board." BID�fE `S SIGNATURE PREVIOUS DISQUALIFICATIONS "I hereby swear, under penalty of perjury, that the below indicated bidder, any officer of such bidder, or any employee of such bidder who has a proprietary interest in such bidder, has never been disqualified, removed or otherwise prevented from bidding on, or completing a Federal, State, or local government project because of a violation of law or a safety regulation except as indicated on the separate sheet attached hereto entitled "Previous Disqualifications." If such exceptions are attached, please explain the circumstances. BIDDSIVS SIGNATURE CERTIFICATION OF WORKER'S COMPENSATION INSURANCE By my signature hereunder, as CONTRACTOR, I certify that I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be Insured against liability for worker's 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. BID&ER'S SIGNATURE City of San Rafael BIDDER CERTIFICATIONS 0045 30 -1 of 2 Essential Facilities Demolition Project— Public Safety Center 00 45 11 - BIDDER REGISTRATION AND SAFETY EXPERIENCE FORM INSTRUCTIONS In order to register to undertake work for the City of San Rafael Bidder must provide the following: 1) Fill out this registration form completely; do not leave blanks. 2) Provide certificates of insurance complying with insurance noted in General Conditions 00 72 13 Section 13 Insurance and Bonds. INDEPENDENT CONTRACTOR REGISTRATION Contractor's License #: 913083 Date: 04/30/2018 Fed I.D. # 45-4137958 Full Corporate Name of Company: CVE Contracting Group Inc. dba Central Valley Environmental Street Address: 4263 N. Selland Ave.. Fresno CA 95722 Mailing Address: 4263 N. Selland Ave.. Fresno CA 95722 Phone: 559-222-1122 Fax: 559-222-1147 Name of Principal Contact: C:i_ tv of San Rnfaal Fssanital Fnnilitiaa nemolitinn Proient - Pi iblic Safety Center Type of Business: Sole Proprietor Partnership Non -Profit 501 C3 Corporation Other (please explain 1 City of San Rafael REGISTRATION AND SAFETY EXPERIENCE FORM 00 45 11 - 1 of Essential Facilities Demolition Project — Public Safety Center A.M. Best Rating: SAFETY EXPERIENCE The following statements as to safety experience of Bidder are submitted with Bid, as part thereof, and Bidder guarantees the truthfulness and accuracy of the information. 1. List Bidder's Interstate Experience Modification Rate for the last three years. 2016: 127% 2015: 130% 2014: 139% 2. Use Bidder's last years Cal/OSHA 200 log to fill in the following: a. Number of lost workday cases b. Number of medical treatment cases c. Number of fatalities 3. Employee hours worked last year 67,940.5 4. State the name of Bidder's safety engineer/manager or Site Safety Officer: Gilbert Sandoval, Superintendent Attach a resume or outline of this individual's safety and health qualifications and experience. BIDDER CERTIFIES, UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA, THAT THE FOREGOING INFORMATION IS CURRENT AND ACCURATE AND AUTHORIZES THE CITY OF SAN RAFAEL AND ITS AGENTS AND REPRESENTATIVES TO OBTAIN A CREDIT REPORT AW/OR VERIFY ANY OF THE ABOVE INFORMATION. SIGNATURE 7/20/17 DATE -END OF SECTION - City of San Rafael REGISTRATION AND SAFETY EXPERIENCE FORM 00 45 11 - 4 of 4 Essential Facilities Demolition Project— Public Safety Center ILLIt•�'r�ti _ . L►ECENT NVIVALLEYRONMENTAL _Y Gilbert Sandoval, Superintendent 4263 North Selland Ave, Fresno CA 93722 Phone: 559-978-1497 Email: gilberts@cvecorp.com EXPERIENCE Central Valley Environmental, Fresno CA, 93722 5/1/2013 to present 5/2013 —4/2016: Performed in role of Foreman with related labor and project management in all areas of Asbestos, Mold and Lead Abatement. Experience includes running large scale projects for the Government, State, Public and Private Entities. 4/2016 -Present: Perform role of Superintendent overseeing all laborers and work being performed under the direction of our Foremen, Leadmen and Laborers on all/every type of Asbestos, Mold and Lead Abatement projects. Restoration Management Companv, Fresno, CA, 93721 11/2010 — 4/30/2013 Asbestos, Mold & Water Technician for a major restoration company. I was part of the castratrophe team that was sent to New Jersey after Hurricane Sandy. Duties include demolition & the remediation of asbestos & mold. Also conduct moisture inspections and the setting up of drying equipment for the purpose of drying out the structures. I am Asbestos and WRT certified. CERTIFICATIONS AHERA Certified Asbestos Removal Supervisor/Contractor CDPH Certified Lead Removal Worker OSHA 10 Department of Transportation - Haz Mat Endorsement 00 45 53 - BASE BID BREAKDOWN ALL Bidders announced at the bid opening shall deliver to the City of San Rafael, c/o the Project Manager, Jamie Milliner, the form below within two (2) working days after the bid opening date and time. Bid Breakdowns received late may be cause for disqualification of Bidders as non-responsive. Each line shall be filled in completely. Leaving blank lines or combining lines may be considered non-responsive. The undersigned, doing business under the firm name of. CVE Contracting Group Inc. dba Central Valley Environmental having submitted a Bid in accordance with the Invitation to Bid and Instructions to Bidders in the following amount; Grand Total Base Bid: ($ is herewith providing the required Base Bid Breakdown as follows: Item Work to be Performed for Public Safety Center 01 Site Parkinq 02 Fire Station 51 03 Blue House 04 Parking Services 05 Hazmat 06 Temporary fencing (to remain in place) 07 Sound Barrier/ Curtain (to remain in place) 08 General Conditions 09 Bonds/insurance 10 Fee/Overhead & Profit Total Cost for Demolition OTHER TOTAL BASE BID: Subcontractor Or Bidder -END OF SECTION - Dollars Dollar Value of Portion of Work to be Performed City of San Rafael BASE BID BREAKDOWN 004553-1 of 7 Essential Facilities Demolition Project— Public Safety Center 00 45 19 - NON -COLLUSION AFFIDAVIT PUBLIC CONTRACT CODE §7106 NON -COLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID STATE OF CALIFORNIA ) ss. COUNTY OF Fresno ) Tim Williamson 1, being first duly sworn, deposes and says that he or she is President [Office of Affiant] of CVE Contracting Group, Inc., dba Central Valley Environmental [Name of Bidder], the party making the foregoing Bid, that the Bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the Bid is genuine and not collusive or sham; that Bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham Bid, and has not directly or indirectly colluded, conspired, connived or agreed with any bidder or anyone else to put in a sham Bid, or that anyone shall refrain from bidding, and that the Bidder has not in any manner, directly or indirectly, sought by agreement, communication or conference with anyone to fix the Bid price of 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, or to secure any advantage against the City of San Rafael, or anyone interested in the proposed contract; that all statements contained in the Bid are true; and further, that Bidder has not, directly or indirectly, submitted its Bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, Bid depository, or to any member or agent thereof to effectuate a collusive or sham Bid. Executed under penalty of perjury under the laws of the State of California: CVE Contracting Group, Inc., dba Central Valley Environmental (Name of Bidder) r (Signal re of Principal) Subscribed and sworn before me This 20th day of July 204 i Notary Public of the Stated My Commission exp I_ . crtr o TIFFANY L. FAHLEY Commission 4r 2139413 Z • Notary Public - California Fresno County c lit� Comm. Expires Jen 7, 2020 (If Bidder is a partnership or a joint venture, this affidavit must be signed and sworn to by every member of the partnership or venture.) (If Bidder [including any partner or venturer of a partnership or joint venture] is a corporation, this affidavit must be signed by the Chairman, President, or Vice President and by the Secretary, Assistant Secretary, Chief Financial Officer, or Assistant Treasurer.) (If Bidder's affidavit on this form is made outside the State of California, the official position of the person taking such affidavit shall be certified according to law.) -END OF SECTION - City of San Rafael NON -COLLUSION AFFIDAVIT 00 45 19 - 1 of 1 Essential Facilities Demolition Project— Public Safety Center INSURANCE Workers' Compensation: Carrier: See attached proof of insurance and related information requested Address: Phone and Fax: Policy Number: General Liability: Carrier: Address: Phone and Fax: Policy Number: Automotive Liability: Carrier: Address: Phone and Fax: Policy Number: Policy Limit $: A.M. Best Rating: City of San Rafael REGISTRATION AND SAFETY EXPERIENCE FORM 00 45 11 - 2 of 4 Essential Facilities Demolition Project— Public Safety Center INSURANCE Workers' Compensation: Carrier: Zurich American Insurance Company Address: 11290 Pyrites Way #200, Rancho Cordova, CA 95670 Phone and Fax: 916-636-0811 Policy Number: WC018075001 General Liability: Carrier: Arch Specialty Insurance Company NAIC#21199 Address: 13841 Southwest Highway, Orland Park, IL 60462-1354 Phone and Fax: 559-374-3560/559-374-3697 Policy Number: 12EMP05300400 Automotive Liability: Carrier: Zurich American Insurance Company Address: See above Phone and Fax: See above Policy Number: BAP01769302 Policy Limit $: 1,000.000 A.M. Best Rating: A+ XV All -Risk Course of Construction: Carrier: N/A Address: Phone and Fax: Policy Number: Policy Limit $: A.M. Best Rating: Professional Liability (if applicable): Carrier: Arch Specialty Insurance Company NAIC#21199 Address: See above Phone and Fax: See above Policy Number: 12EMP0530402 Policy Limit $: 1,000,000 A.M. Best Rating: A+ IX Environmental Impairment Liability (if applicable): Carrier: Arch Specialty Insurance Company NAIC#21199 Address: See above Phone and Fax: See above Policy Number: 12EMX0560700 Policy Limit $: 1,000,000 ___+, CVECONT-01 EBARTSCH ACODI " CERTIFICATE OF LIABILITY INSURANCE DAT8(MMIDD6 ) tllwTHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to l the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Elaine Bartsch NAME: Fresno CSG-Alliant Insurance Services, Inc. PHONE FAX 9 E. River Park Place East Ste 310 A/c No Ext), IANC. No): Eebartschalliant.com -MAIL _ Fresno, CA 93720 ADDRESS: _ INSURER(S) AFFORDING COVERAGE NAIC# _ INSURERA:Arch Specialty Insurance Company 21199 INSURED INSURERB:Zurich American Insurance Company 16535 CVE Contracting Group, Inc. DBA: Central Valley 1 INSURERC: Environmental 3443 W. Gettysburg INSURER 0: - Fresno, CA 93722 INSURER E: _ I INSURER F; COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PEIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH RTHIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH-'OLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY 'AID CLAIMS INSRTypE OF INSURANCE ADDLSUBR POLICYEFF POLICYEEP LIMITS LTR INSD WVO POLICY NUMBER IMMIDD/YYYY) (MMIDDA'Y" A 7MERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,0001 ❑X 12EMP0530402 08/0112016108101/2017—OTWACE TO HEN I EU 50000 CLAIMS -MADE OCCUR PREMISES fEa ocoJrrencel $ r MED EXP (Any one person) $ 6,000 PERSONAL B ADV INJURY $ 1,000,0001 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY jEO � LOC PRODUCTS-COMP/OP AGO $ 2,000,00 OTHER:applies to GL only POLL PROF LIAB $ 1,000,00 AUTOMOBILE LIABILITY GOMBINED SINULE LIMIT $ 1,000 0001 fEa accitlentl r B %t ANY AUTO BAP017629302 08/0112016 08101/2017 BODILY INJURY (Per person) $ 1 ALL OWNED SCHEUTODULED BODILY INJURY (Per accident) $ AUTOS NON -OWNED PROPER-ZDAMAGE $ _ HIRED AUTOS AUTOS Per accltlentl UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4,000,000 /{ X EXCESS LIAB H CLAIMS -MADE 12EMX0560700 08/01/2016 08/01/2017 AGGREGATE $ 4,000,000 DED RETENTION$ $ j WORKERS COMPENSATION X STATUTE I ERH AND EMPLOYERSLIABILITYYIN WC018075001 08/01/2016 08/01/2017 Ei EACH ACCIDENT $ 1,000,0001 B OFFICER RIETOR/PARTNER/EXECUTIVE ❑ N/A (Mandatory In N R EXCLUOED4 (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $ 1,000,00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (I CORD 101, Additional Remarks Schedule, maybe attached if more space Is required) RE: For Information Purposes Only CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Information Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD