Bid Page I - Caltrans · Page I of 2 Only an individual who is authorized to bind the bidding firm...

ATTACHMENT 6 BID/BIDDER CERTIFICATION SHEET

Invitation For Bid IFB Number 04A539 I

Page I of 2

Only an individual who is authorized to bind the bidding firm contractually shall sign the Bid/Bidder Certification Sheet. The signature must indicate the title or position that the individual holds in the firm. This Bid/Bidder Certification Sheet must be signed and returned along with all "required attachments" as an entire package with original signatures. 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. All required attachments are included with this certification sheet. C. I have read and understand the DBE participation requirements and have included documentation demonstrating

that I have met the participation goals. D. The signature affixed hereon and dated certifies compliance with all the requirements of this bid document. The

signature below authorizes the verification of this certification. E. The signature and date affixed hereon certifies that this bid is a firm offer for a 90-day period.

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

3. Address

q75 (u_vd-ev1 ~f-. '5u.v, L~ClV\.d. va Cct. q Lfc(7J Indicate your organization type: 4. D Sole Proprietorship 5. D Partnership

Indicate the applicable employee and/or corporation number:

6. Corporation

_7._F_ed_e_ra_l_E_m_p_lo_y_e_e_I_D_N_o_._(_F_E_IN_) _ _,__,__"-"--'-'..._.......,,S"'---=----'---8._C_a_lif;_o_rn_i_a_C_o_rp_o_ra_t_io_n_N_o_.__,>-<-+-""'--'---"::.......:..-"-- 0

Indicate the Department ofindustrial Relations information: 9. Contractor Registration Number / 0 0 Q Q ]._,, I/ 1.,,- 0 ~ Indicate applicable license and/or certification information: 10. Contractor's State Licensing

Board Number / 0 0 3 ti / J 11 . PUC License Number

CAL-T- N /4

15. Date

16. Are yo certified with the Department of General Services, Office of Small Business and Disabled Veteran Business Enterprise Services (OSDS) as: ¥ a. Small Business Enterprise Yes D No b. Disabled Veteran Business Enterprise Yes D No)6' If yes, enter certification number: If yes, enter your service code below:

NOTE: A copy of your Certification is required to be included if either of the above items is checked "Y cs".

Date application was submitted to OSDS, ifan application is pending: N 4

STATE OF CALIFORNIA · DEPARTMENT OF TRANSPORTATION

BID PROPOSAL ADM-1412 (REV. 11 /2015)

CONTRACTOR'S NAME (Please Print):

ITEM ESTIMATED UNIT OF NO. QUANTITY MEASURE

I 5000 One ( 1) Hour

2 500 One ( I) Hour

3 (000 One (1) Hour

4 100 One ( I) Hour

5 3500 One (I) Hour

6 350 One (I) Hour

7 6000 One (1) Hour

8 600 One ( I) Hour

9 2,500 One (I) Hour

10 1850 One (I) Hour

11 23000 One (I) Linear Foot

12 2600 One(!) Linear Foot


14 8000 One ( I) Linear Foot

15 4500 One ( I) Linear Foot


17 6500 One ( 1) Linear Foot

(8 10,000 One (I) Linear Foot

ATTACHMENT 1

ITEM

Journeyman Electrician rate

Overtime Journeyman Electrician rate

Journeyman Apprentice Electrician rate

Overtime Journeyman Apprentice Electrician rate

Laborer rate

Overtime Laborer rate

Telecommunications Technician rate

Overtime Telecommunications Technician rate

Systems Engineer

Traffic Control per Exhibit A, Scope of Work, Item 16

Copper Wire Replacement (up to number 6 A WG)

Conduit Replacement (up to 3" diameter)

Fiber Optic Cable - Drop Installation (12-strand, SM)



Fiber Optic Cable - Drop Installation (!44-strand, SM)

Four Inch (4") Conduit with Inner-duct Instal lation

Outdoor Network Straight Through Data Cable Installation

Agreement Number 04A5391 Page 1 of 4

UNIT PRICE (Price Per Unit of

Measurel

$ \ 5-~--$ L\.pO. -$ t 1-a.--$ 2-1 ~--$ Cf) 'f.() . -

$ f 2.G.-$ ' \ 2 .-$ 110r $ 2-/ 4-. -$ 7 15 .-$ 1. 9<:) $ ES.-$ '2 , fs-4 $ 3 ,17 $ S -1O $ <.o -45 $ 45.-$ 2 ,SO

SUBTOTAL PAGE l (Items 1-18)

TOTAL (Estimated Quantity

X Unit Price)

$7CJ5,oo-v. $ $ $

16O . 0Q ll.G, 0D1

Q .

Q. -1-1, sDv

$ 301,00 D--$ 4-1..000 $ v l2,0C uo,-$ IG2 1 00(;

$ ':::>3~.GO'O ().-$ 7 1..67, 1 s,

$ Y~ 1lDQ. $

$ 91, 00 27-,ll.

Q.D,-

$ 2':> , ?,(ti().

o.-$ L--S1V~C

$ I 1-,900 -oo. $ 2.91-. SC

$ 2-S DGO O<oO.-s 4, 02-5. C

ATTACHMENT 1 ITEM ESTIMATED UNJTOF NO. QUANTITY MEASURE ITEM

19 130 Each Ethernet Edge Switch Installation (Copper)

20 90 Each Ethernet Edge Switch Installation (Fiber)

2 1 130 Each Fiber Patch Panel Installation ( 12-nort)

22 25 Each Fiber Patch Panel Installation (72-nort)

23 35 Each Fiber Optic Spl ice Enclosure Installation

24 90 Each Traffic Rates Fiber Optic Pull Box Installation

25 35 Each Fiber Optic Splice Vault Installation

26 1800 Each Perform Field Fiber Optic Fusion Splice and OTDR Testing

27 3 Each Router Replacement (Hub)

28 3 Each Ethernet Switch Replacement (Hub)

29 2 Each Fie ld Aggregation Switch Replacement

30 JO Each LED EMS Sign Panel Replacement

3 1 10 Each EMS Control Panel & Assembly Replacement

P- -1-Q -ea£h },1M8 8igA ll!lf!el aAEI GeAtFelleF ,6,ssemely R:e13laeemeAt

;.; -1-Q -ea£h l.ll'•,48 GeHtcFel ll!lf!el & ,6-ssemely R:e13laeemeAt

34 I Each VMS Sign Panel and Controller Assembly Replacement (Color)

35 4 Each VMS Control Panel & Assembly Replacement (Color)

36 4 Each Variable Advisory Speed Sign Replacement

37 4 Each In formation Message Sign Panel Replacement

38 4 Each Information Message Sign Controller Replacement

39 5 Each Model 334T Contro ller Cabinet Replacement CCTV

Agreement N umber 04A5391 Page 2 of 4

UNlT PRICE (Price Per Unit of

Measure)

$ 3;75G .-$ 4--'0'00 .-

$ l I '-t-'0C) .-

$ 45:J0Q.

$ l,'Ol S .-$ 2-, t:)0() .-

$ 5,0QQ.-$ sio .-$ /.-4 I Q~l ).''"

$ 31,,,~\J\J.

$ 1.. 9'0\) \) .-. $ ( \0,0\)\) ,-

$ '7]__~ o .-$ NI v,--

$ N/;4-

$ I "<>'10 00· I

$ <o,s00--$ \0 co ,ovv-· $ 31 O\JO ··

$ I '() , 0\)0 .-

$ j1_,\)\')\),-

SUBTOTAL PAGE 2 (Items 19-39)


X Unit Price)

$ %7,SO(J

$ 300, ooc o.-$ l'()L.-)0\JO $ \'LO, O\JQ $ (oS,\02.. s.

D·t) . -

$ 2-s2, oo $ 2-iO,OQ $ I 'OW-, 4-00

$ <2:i,,O00. $ 9wo~o .-

$ 1::, c,o o o. -$ I \0 0 , 000 $ )7-,SOQ·

$ /J / flt-

$ N/f1-$ l'oC/,o oo .-$ 34,000.-

$ 2. 71-, 0\JQ·

$ \%.ooo--$ 40, 000· -

--$ \.DOiO\)Q.·

$ ~1049), () 1.,5. -

ITEM ESTIMATED UNIT OF NO. QUANTITY MEASURE

40 150 Each

4 1 2 Each

42 4 Each

43 4 Each

44 4 Each

45 4 Each

46 4 Each

47 4 Each

48 4 Each

49 4 Each

50 11 0 One ( l )

Linear Foot

51 25 Each

52 90 Each

53 17000 One (I)

Linear Foot

54 90 Each

55 20 Each

56 10 Each

57 10 Each

58 5 Each

59 l Lump Sum

ATTACHMENT 1

ITEM

Traffic Rated Pull Box and Lid Replacement (up to number 6 pull box)

Lane Use Sign Replacement

Antenna Replacement (HAR)

Cabinet Assembly Replacement (HAR)

Chassis Replacement (HAR)

Transmitter Replacement (HAR)

Digital Recorder-Player Module Replacement (HAR)

Power Supply Module Replacement (HAR)

AC Rack Replacement (HAR)

Battery Backup System Replacement (HAR)

CCTV Camera Replacement (PTZ)

CCTV Camera Replacement (Fixed)

CCTV Camera Controller Replacement

CCTV Camera Cable Replacement

CCTV Video Encoder Unit Replacement

Router Replacement (Field)

Type 3 Service Cabinet Replacement

Telecommunication Distribution Cabinet Replacement (Type B)

Model 334L Controller Cabinet Replacement (TOS)

Stom1 Water Pollution Control Plan

Agreement Number 04A5391 Page 3 of 4

UNlTPRJCE TOTAL (Price Per Unit (Estimated Quantity

of Measure) X Unit Price)

S\~f"SQ--)

s 1-crz_, ~o O - -

$ \...\-1-5~"1-- $ cos ,ooo--S Y.-,"1-SO; $ 17 100() .-

s S ,S'\)\J-- s 2- L , \.'.:J \)\) .-

$ 4 ,SXA) . - s I 'OJ.)00 .-

s i'O, OD\J 7 $ 4\J, 0\)\) . -

$ \4, c;.~~ -- $ 6~)0~0 --

$ 4 ',_~ \) .- $ I/ I OQQ --

s 42-S'Q--I

s 17 O'QQ--

s lJ-,SoQ-- $ I Cf) ,0 \JQ . -

s lo.SW -- s 7 IS. O\)\J .-

s '?Alf 5 .-- $ 9C1 J 'b 7 s '_, s 7-/10() ;- $ 1.'01,0QO- ·

S /0-'bO $ I <'a~' l.oQ() . -

$ -z_., \\)\)~ $ I '69, OOG--s-s.soo .- $ \l 0,0\J'O--$ ,, \00\J ,- $ I \o I O\JD. -s 4;i.. Se> _. i. $ 4'2.-,5:\J\J ·-S 1\,$\)\) .- $ s;-7,soo .-$ 2. .s °\) 'v .- s 2-, SoQ.-

SUBTOTAL PAGE 3 (I tems 40-59) $ ?..., 3LI I 4-7~.

ITEM NO.

60

61

62

63

64

65

66

Agreement Number 04A539 1 Page 4 of 4

ATTACHMENT 1 UNIT PRICE

ITEM ( Price Per Unit of Measure)

Miscell aneous materials and supplies (not included in items 1-59 listed above) for equipment and parts and miscellaneous equipment rental per Exhibit B, Item 6, Materials/Supplies and Equipment Rentals.

SUBTOTAL PAGE I (Items 1-18)



SUBTOTALPAGE4 Q~ms6~

FINAL SUBTOTAL (Items 61-64)

Maximum allowable expenditure fo r miscellaneous materials and supplies as defined in Exhibit B, Item 6 Materials/Supplies and Equipment Rentals. Actual costs shall be reimbursed based on submitted original receipts and invoices. THIS AMOUNT SHALL BE 10% OF THE FINAL SUBTOTAL (0 .10 x final subtotal}.

(I) 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.

TOTAL THIS

(2) IN CASE OF DISCREPANCY BETWEEN THE UNIT PRICE AND THE TOTAL SET FORTH FOR A UNIT BASIS PROPOSAL

JTEM, THE UNIT PRlCE SHALL PREY AIL. (Items 65 + 66)


X Unit Price)

$610,000.00

$ 4, ~1-S i 01:) ,0. -

1,S.

,s,-$ 6,04-~,0

$ 2.,32../,L)

$6 10,000.00

$ \()I ()()'-fl

$ I, OQO , Y

St)Q.

sco . -

$ I I , 0'() S ; O~t).-

Attachment 2 Agreement 04A5391

Page 1 of 1 STATE OF CALIFORNIA DEPARTMENT OF TRANSPORTATION SUBCONTRACTING PROVISIONS/Ll~T Form ADM 1511 (REV. 9/06)

List all subcontractors that will be used in this Agreement. All subcontractors listed below must be used in accordance with the Agreement. This includes, if applicable, compliance with the subcontracting provisions and any Disabled Veteran Business Enterprise (DVBE), Small Business, Micro-Business, and Disadvantaged Business Enterprises (DBE) subcontractors. If none, bidder to write "NONE" in this space.

NAME BUSINESS ADDRESS DESCRIPTION OF PORTION OF WORK WHICH WILL BE DONE BY EACH CONTRACTOR*

w ~ ~-e " T --e.' -e., t ~ VV\. V\/\ • \ "' (. I i q 9 s , itw ~ \D s I v...1/1 " c,:,-\ u. (\. d c lt . ts\.l) <r ~ r- ' 'O -e V I e o vv-. VV\ V \j"\ l c °" n. 0V) s

w-e..s \-e VV\ t 1/'U th G s,.{>(:Jl ~ ?:>ct '-f L- J ()._\\-{_Vi, Av-e 1 & ~ I \-e, t--f I

P \-e u. ".::>¼.\A nJV"l C. ( / I, • C\. 4 S v '-P \ VC\ Ci, (. ~ Uv'\ fv.o I

STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION

DISADVANTAGED BUSINESS ENTERPRISE (DBE) INFORMATION ADM-0227F (Rev. 06/2012) (CONTRACTS FEDERALLY FUNDED IN WHOLE OR IN PART)

Attachment 3 . Agreement 04A5391

Page 1 of 2

PART A - CONTRACTORS INFORMATION (Refer to Instructions on Page 2 of this form. Bidder/Proposer shall ensure all information provided Is complete and accurate.)

CONTRACTOR'S BUSINESS NAMj:: /)J_ _ . , . 1

_ • . L ~ tGREEMENT NUM .. BER IC~ TRACT DOLLAR AMOUNT \J, . tyllv'\ (,,( ~ t -fc rYI C, LL 09v9 03tt \ ~ fl, a o5 l 03"i?. ~ DATE I 1 2-4/ ) '5

CANTRACTOR'S BUSIN~SS ADDRESS I CITY,- I I ST N E '-17 S (a.v-·c1:f,/ l Si-V-t~ "t°' \..Ju.. ii"\ L-e a_,/\ ri ...-n l U

ZIP coDq l/ S: T--)__ C~ C~ PERSONL ... , J I BUSINESS PHONE !FAX NUMBER . . C ~ .7WV\Cf vLQ-v-- ( S I> U \Q 6 '1 0 lo 3 '1 ( S 1 C> ~ ~ '1 q f ( v

E~ IL ADDRESS 1---JGf, l i W\

T =e--1~c ~~

PART B - DBE INFORMATION AND DOCUMENTATION (Refer to Instructions In Page 2 of this form. Bidder/Proposer shall verify DBE certifications.) Contractor shall attach a copy of the bid (or price quote) from the DBE (on the DBE's Letterhead) for all DBEs listed below.

(1) Prime and Subcontractors: List Name(s) and addresses (2) Area Code & (3) (4) Description of Work, (5) DBE or CUCP (6) (7) DBE (8) (9) Caltrans

of all DBEs that will participate in this Agreement: Phone Number Tier Service, or Materiel Supplied Certification Ownership $ Amount Claimed %of $Value

Use Only% Number. Code Claimed

LOG-!,~ -r-, c u..1 CV\\-tv-pv-1 ~-ej ssq -7t:t7 -\ t \-fc m ·c.(A \ MC\-\tv,C{\S 'bC{4~U 7 $1, 0~3,1~1 9,2-1/,

'cl, -A V\)V\/\ S N-e. C. \-:iv, S. Ll..l '13 \) 1'2- 4-~?:>'-\ (o lta c.. v1ecO

\,'J~~re,VV\ T..,-u_ Ef,C... S"'pvl'f qi.i;-2-'-\q-I Tvo_ fh L CW\-\-vo"l 4G\:l~ \ 2 i~ 1-i..,t, 11..sv 5 .4·/~

39.4"1.. Ve,t\\t-.,i Av-e,, ,~.._\ 1+f 1--1 to SL\- ~e-~ ,, ~ ,,

;:> 1€'-l.~Clv'\~ CC.\ . Ct 4.S-'-D \.()

PART C - FOR CAL TRANS USE ONLY (Verification Completed by Civil Rights, Office of Business and Economic Opportunity):

PRINT VERIFIER'S NAME AND TITLE !SIGNATURE !DATE CIVIL RIGHTS STAMP OF APPROVED

DBE PARTICIPATION D YES ( %) ONO

~

LOGISTICAL ENTERPRISES

(559) 797-4034

To: St Francis Electric 975 Carden Street San Leandro, CA 94577

CT#04A5391 Maintenance Contract

BID ITEM DESCRIPTION

Bl#17 4" Conduit with lnnerduct

Bl #18 Outdoor Network Straiaht Thru Data Cable

Bl#24 Traffic Rated Box Fiber Box

Bl #25 Fiber Optic Splice Vault

Bl #30 LED EMS Siqn Panel

Bl #31 EMS Control Panel

BI#34 VMS Sian Panel - Color

Bl#35 VMS Control Panel - Color

BI #36 Variable Advisorv Saeed Sian

Bl#37 Information Messaae Sian Panel

Bl #38 Information Messaae Sian Controller

Bl#39 Model 334T Controller cabinet

Bl#40 Traffic Rated Box Uo To #6

BI#41 Lane Use Sian ILUS)

Bl #50 CCTV Camera - PTZ - WTI

Bl#51 CCTV Camera - Fixed -WTI

Bl #52 CCTV Control Unit - WTI

Bl#53 CCTV Camera Cable 1150' Lenath) -WTI

BI #54 CCTV Video Encoder Unit

BI#55 Router - Field

Bl #56 Tvoe Ill Service Enclosure

BI #57 Tvoe B TDC

Bl#58 334L Cabinet - TOS

QUOTE

QTY

6500

1000

90

35

10

10

1

4

4

4

4

5

150

2

110

25

90

110

90

20

10

10

5

PRICE

$ 4.07

$ 0.67

$ 906.00

$ 3,580.00

$ 7,160.00

$ 1,288.00

$ 108,345.00

$ 4,605.00

$ 41,995.00

$ 20,035.00

$ 5,280.00

$ 6,165.00

$ 625.00

$ 24,400.00

$ 3,399.00

$ 1,495.00

$ 1,339.00

$ 696.00

$ 980.00

$ 2,936.00

$ 3,667.00

$ 1,236.00

$ 6,165.00

SUBTOTAL:

Date: January 18, 2018 Quote# DR011 818B Expi 30 Days

U/M TOTAL

FT $ 26,455.00

FT $ 670.00

EA $ 81,540.00

EA $ 125,300.00

EA $ 71 ,600.00

EA $ 12,880.00

EA $ 108,345.00

EA $ 18,420.00

EA $ 167,980.00

EA $ 80,140.00

EA $ 21,120.00

EA $ 30,825.00

EA $ 93,750.00

EA $ 48,800.00

EA $ 373,890.00

EA $ 37,375.00

EA $ 120,510.00

EA $ 76,560.00

EA $ 88,200.00

EA $ 58,720.00

EA $ 36,670.00

EA $ 12,360.00

EA $ 30,825.00

$ 1,722,935.00

X .. <;;o

Western Traffic Supply, Inc.

"Yau, /load T,:, Safety" Lie. 11974188, C-31, C-32

3942 Valley Ave., Suite M Pleasanton, CA 94566 Phone: (925) 249-1854 Fax: (925) 249-1863 www.westerntraffic.com UNION CONTRACTOR

To: Estimating at St. Francis Electric

Re: Caltrans 04A5391; Multi-Provider

Electrical System Rehab & Restoration

Bid Date: 1/18/2018

Bid Items: 9

DBE Quote Certified DBE/SBE CUCP Firm ID No. (DBE): 40681 CA DGS ID No, (SBE): 35779 Contractor's License No.: 974188; C-31, C-32 DIR Registration No.: 1000003313 FEIN: 45-5320385 SF Vendor No.: 77629

From: Ed Ibanez; [email protected]

Pages: 3

Bid Submitted: 1/11/2018

13.5 % DBE Goal I D Urgent I [8J For Review I D Please Comment I D Please Reply I D Please Recycle

A Certified Small Business (SBE #35779)

& Disadvantaged Business Enterprise (DBE #40681)

'>)

Traffic Control Service, Sales & Rental

Traffic Control Service Sales Rental • Road Lane Closures • PCMS • PCMS • Highway Closures • Arrow Boards • Arrow Boards • Flaggers • Signs • Traffic Control Trucks

• Barricades • Attenuator Trucks • Traffic Cones • Light Towers • Safety Apparel • Barricades/Signs/Cones

~~;;;;,~~ Uc. #974188, C-31, C-32

Bid Description uo QTY Unit Total Item M Cost 9 TRAFFIC CONTROL SYSTEM

2-Person Lane Closure Daily Rate DAY $ 1550

• Includes a 2-Person crew; 8 HR minimum; 1/2 day minimum /NT charge; Full shift charge after 4 hours; Overtime (beyond 8 hours) to be billed at $240 per crew hour (includes up to 200 cones, 2 flashing arrow signs, applicable equipment to close up to 2 lanes in one direction, (4) beacons with batteries and (18) flag stands)

• Add $190 per shift for Portable Changeable Message Sign (if needed)

• Additional Lane/Direction or Ramp Closure $110 each

3-Person Lane Closure Daily Rate

Includes a 3-Person crew with an Operated Attenuator Truck - --• e I) (includes mileage); 8 HR minimum; 1/2 day minimum charge; Full DAY $

shift charge after 4 hours; Overtime (beyond 8 hours) to be bi lled /NT

at $405 per crew hour Z"SO/ ~ (includes up to 300 cones, up to 12 signs and stands, 2 flashing

arrow signs, applicable equipment to close up to 2 lanes in one direction, (2) beacons

-:::. 33 \. ~

• Add $190 per shift for Portable Changeable Message Sign (if needed) '33\. 2-''-\ \~5D( ll-l

• Additional Lane/Direction or Ramp Closure $110 each v=/ Cl2/i ;25 C ----

SEE ATTACHMENT A FOR TERMS & CONDITIONS TO BE INCLUDED AS PART OF THIS QUOTE

~ ~

**We are a certified DBE and SBE**

Western Traffic Supply, Inc. Caltrans 04A5391; Bid Date 1/11/18 Page 2 of 2

ATTACHMENT 8

STATE OF CALIFORNIA· DEPARTMENT OF TRANSPORTATION BIDDER/PROPOSER DISADVANTAGED BUSINESS ENTERPRISE (DBE) GOOD FAITH EFFORTS DOCUMENTATION ADM-0312f (REV 06(2012) Page 1 of 4

Agreement 04A5391 Page 6 of9

CONTRACTOR'S NAME l t .1'v(iv\Ll & -"t I fC tvl 'C I

l l C ___ J 'FB o::FP OR RF-~4-EVi-~ 3 q I BIDDER/PROPOSER INSTRUCTIONS: Submittal of only the Disadvantaged Business Enterprise (DBE) Information/Participation form, ADM-0227f, may not provide sufficient documentation to demonstrate that adequate good faith efforts (GFE) were made by the bidder/proposer. Bidder/proposers prosing goal attainment should always submit documentation for making GFE to protect its eligibility for award should Caltrans, in its evaluation, find that the goal was not met. Examples of disqualification may include but are not be limited to: 1) A DBE subcontractor was not certified by Caltrans or a state or local participating agency that has a reciprocal agreement with Caltrans, by the bid/proposal due date and time; or 2) Bidder/proposer made a mathematical error resulting in failure to meet the goal. Bidder/Proposer must make an adequate GFE to be responsive. When applying for a determination of a GFE when no contract goals have been attained or when only partial goal(s) have been attained, bidders/proposers shall complete this Bidder/Proposer Disadvantaged Business Enterprise (DBE) Good Faith Efforts Documentation form, ADM-0312f, and submit the requested information below with its bid by the bid due date and time. Bidder/Proposer is responsible to: (1) ensure information is complete and accurate, and (2) verif y DBE certifications. 1. ADVERTISEMENT DOCUMENTATION List names and dates of each general circulation newspaper, trade paper and minority focused paper or other publication in which a request for DBE participation was placed. Attach a

,f the advertisement or proof of · ·· ·-·· TITLE OF PUBLICATION PUBLICATION DATE(S) TITLE OF PUBLICATION PUBLICATION DATE(S)

r

f\J / /} - Ir-, I

2. DBE DOCUMENTATION a. List the names and dates of written notices sent to certified DBE firms soliciting bids for the contract. b. List the dates and methods used for following up initial solicitations to determine with certainty whether or not the DB Es were interested. c. Attach a copy of any solicitation package, phone records, fax confirmations or solicitation follow-up correspondence sent to DBE firms. d. ldentifi information submitted to the bidder for this solicitation:

Check the appropriate box: 0 IFS O RFP O RFQ

SOLICITATION DATE DATE DATE OF FOLLOW-UP METHOD

MAILED PHONED FOLLOW-UP PHONE/EMAIL NAME OF FIRM SOLICITED CONTACT NAME PHONE NUMBER

,t._ J I 11 /V I tl1

I

ATTACHMENT 8

STATE OF CALIFORNIA· DEPARTMENT OF TRANSPORTATION


BIDDER/PROPOSER DISADVANTAGED BUSINESS ENTERPRISE (DBE) GOOD FAITH EFFORTS DOCUMENTATION ADM-0312f (REV 6/2012) Page 2 of 4

CONTRACTOR'S NAME ·c,LL, ~ 2. DBE DOCUMENTATION (Continued)

SOLICITATION

DATE DATE DATE OF FOLLOW-UP METHOD MAILED PHONED FOLLOW-UP PHONE/EMAIL

NAME OF FIRM SOLICITED CONTACT NAME PHONE NUMBER

I !\J IL

//'

3. ITEMS OF WORK Identify the items of work made available to DBE firms, including, where appropriate, any breakdown of the contract work into economically feasible units to facilitate DBE participation. Bidder/Proposer shall demonstrate that sufficient work to facilitate DBE participation was made available to DBE firms. ITEMS OF WORK:

BREAKDOWN OF ITEMS:

ATTACHMENT 8

STATE OF CALIFORNIA · DEPARTMENT OF TRANSPORTATION



CONTRACTOR'S NAME

'G L/!_ DATE 1 !z_ 4 . . DBE RESPONSES List the DBE firms that responded or submitted bids/proposals to your solicitation for participation in this contract that were not accepted. Provide a summary of your discussion and/or negotiations with each,

d for that portion of work. and the reasons for vour choice. Attach copies of Quotes from DBE firms contacted

DBE FIRM NAME PHONE NUMBER RESPONDED SELECTED GIVE REASON FOR NON-SELECTION AND YES NO YES NO A SUMMARY OF DISCUSSIONS

i

" ) ' /1 I I( I (

5. ASSISTANCE TO DBEs - Bonding, Insurance, etc. Identify efforts to assist DBEs in obtaining bonding. lines of credit, insurance, and/or any technical assistance related to requirements for the work or for plans and specification provided to DBEs.

ATTACHMENT 8

STATE OF CALIFORNIA· DEPARTMENT OF TRANSPORTATION


Agreement 04A5391 · Page 9 of 9

coNTRACTOR'SNAMEd' t ~-=fi,~u· s. t l-rc,,fvJ'C1

LL c I 'Fso1>1/n~~'qs , R I DATE , 12 6.ASSISTANCE TO DBEs - Equipment/Materials, etc. Identify efforts made to assist interested DBEs in obtaining necessary equipment, supplies , materials, or related assistance or services excluding supplies and equipment the DBE subcontractor purchases or leases from the _e_rime contractor or its affiliate.

7. ADDITIONAL DATA Provide any additional data to support a demonstration of GFE such as contacts with DBE assistance agencies. Identify the names of agencies, organizations, and groups providing assistance in contacting,

NAME OF AGENCY/ORGANIZATION METHODS/DATE OF CONTACT RESULTS

I

Ill I A-711 I

ADA Notice For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916) 654-3880 or write Records and Forms Management, 1120 N Street, MS-89, Sacrament, CA 95814.

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