HomeMy WebLinkAboutVCI Herbert Walkup Bid Forms less subcontractor (1)_RedactedSECTION 00 41 00
BID FORMS
BID TO
SOUTH TAHOE PUBLIC UTILITY DISTRICT
for the Construction of
2024 HERBERT WALKUP PIPELINE REPLACEMENT PROJECT
DOCUMENTS IN THIS SECTION CONSTITUTE THE BID FORMS. BIDDERS ARE TO
COMPLETE AND ATTACH THE DOCUMENTS CONTAINED IN THIS SECTION AS
INSTRUCTED IN SECTION 0020 00, INSTRUCTIONS FOR BIDDERS, AND SUBMIT THE
COMPLETED BID PROPOSAL PACKAGE IN ITS ENTIRETY ELECTRONICALLY PRIOR TO
THE BID DEADLINE. BIDDER IS REQUIRED TO SUBMIT THE ORIGINAL DOCUMENTS
CONTAINED IN THIS SECTION WITHIN THE TIME STATED IN SECTION 00 10 009
SOLICITATION — INVITATION TO BID (SEE SECTION 00 20 00, INSTRUCTIONS FOR
BIDDERS, PART 2.03)
Name
Bidder: f v' n c i c(aerli ConscrvcaiOA 2'nc
Business
Address:
Phone No:
To South Tahoe Public Utility District:
Pursuant to and in compliance with your Notice Inviting Bids and the other documents relating
thereto, the undersigned, Bidder, being fully familiarwith the terms of the Contract Documents, local
conditions affecting the performance of the Contract, the character, quality, quantities, and the
Scope of the Work, the cost of the Work at the place where the Work is to be done, hereby
proposes and agrees to perform within the time stipulated in the Contract, including all of its
component parts and everything required to be performed, and to furnish any and all of the labor,
material, tools, equipment, transportation, services, permits, utilities, and all other items necessary
to perform the Contract and complete in a workmanlike manner, all of the Work required in
connection with the construction of said Work, all in strict conformity with the Specifications and
other Contract Documents, including Addenda Nos. 'L .
for the prices hereinafter set forth.
Bids that are submitted via the District's electronic bidding system at the time set foropening of Bids
shall be irrevocable, and may not be withdrawn for a period of sixty (60) days after the date set for
the opening of the bids except as noted in Section 00 20 00, Part 3.14.
ELECTRONIC BID SCHEDULE PRICES:
NOVMEBER 2023 SECTION 00 41 00
2024 HERBERT WALKUP PIPELINE BID FORMS
REPLACEMENT PROJECT 1
All applicable sales taxes, State and/or Federal and any other special taxes, patent rights, or
royalties are included in the prices quoted in this Bid.
The quantities specified are the DISTRICT's estimates and are approximate only, being given as a
basis for the comparison of Bids. The DISTRICT does not, expressly or by implication, agree that
the actual amount of work will correspond therewith. The total amount bid will be used to determine
the lowest, responsive, responsible, Bidder.
Payment for each item will be based on the actual quantity of work performed times the item unit
contract price. Determinations of the actual quantities and classifications of unit price work
performed by the CONTRACTOR will be made by the DISTRICT and may be more or less than the
specified, estimated quantities. Unless otherwise indicated in the Bid Item Descriptions, the unit
price shall be valid for actual quantities up to 25% more than or less than the bid quantity.
All representations made by Bidder in this Bid are made under penalty of perjury.
DATED: !1 d! 15/a, BIDDER: V1 nCI'ConscPvc•x;an� JAC
'1 C• BY: A V S -c; rf
SIGNATURE LI
TITLE: Pre- d�'f-
IN
Z - r .'
a -1 N, ,~ -
NOVMEBER 2023 SECTION 00 41 00
2024 HERBERT WALKUP PIPELINE BID FORMS
REPLACEMENT PROJECT 2
INFORMATION REQUIRED OF BIDDER
DEPARTMENT OF INDUSTRIAL RELATIONS REGISTRATION:
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. i 0 p pD b H 3 y 8
Contractor DIR Registration Number:
LIST OF SUBCONTRACTORS:
The Bidder shall list in the space provided, the name and the location of the place of business of
each Subcontractor who will perform work or labor or render service to the prime CONTRACTOR in
or about the construction of the work or improvement, or a Subcontractor licensed by the State of
California who, under subcontract to the prime CONTRACTOR, specially fabricates and installs a
portion of the work or improvement according to detailed drawings contained in the plans and
specifications, in an amount in excess of one-half of one percent of the prime contractor's total bid
or, in the case of bids or offers for the construction of streets or highways, including bridges, in
excess of one-half of one percent of the prime CONTRACTOR'S total bid or ten thousand dollars
($10,000), whichever is greater. The Bidder shall list the Subcontractor's License Number and, in
accordance with Labor Code Section 1725.5 and 1771.1, the Subcontractor's Department of
Industrial Relations Registration Number. The Bidder shall also list the portion of the work that will
be done by each Subcontractor under this Contract. The prime CONTRACTOR shall list only one
SUB -CONTRACTOR for each portion as is defined by the prime contractor in his or her bid. Failure
to list subcontractors with portions of the Work in excess of the minimum amounts listed above
constitutes a declaration by the CONTRACTOR that it is qualified and able to self -perform the work.
Any CONTRACTOR found to be unqualified or unable to self -perform any part of the Work not listed
below may be disqualified. The Bidder's attention is directed to the provisions of Section 00 73 00,
Supplemental Conditions, Part 2.06, entitled Subcontracts.
NOVMEBER 2023 SECTION 00 41 00
2024 HERBERT WALKUP PIPELINE BID FORMS
REPLACEMENT PROJECT 3
EQUIPMENT/MATERIAL SUPPLIER LIST:
The Bidder shall indicate below which Supplier the Bidder intends to use to furnish under the Bid
each item of equipment or material listed on this form by writing the supplier's name.. Unless the
use of alternatives for a particular item has been restricted by these Contract Documents, the
Bidder may list any manufacturer whose product meets all of the requirements and technical criteria
specified. The listing of more than one supplier for each equipment/material to be famished with the
words "and/or" will not be permitted.
Equipment/Material Supplier Manufacturer
1. Aggregate base material R¢cyc4ed 'r oe Asphalt' -t'a+we- As jaha►t
V 1 0-9 i A C i n d"i - C.: R cl er-i, + e
2. Asphalt
--"oe. Ayh-lr Asph,,l#-
3. Concrete
rj;4rr� rer "w,ht, S� Glrb� Ta h�
R�r � x, ��. y A x
4. Water Piping t/A t•c p
C �4 P FL- c�
5. Water Fittings
TyL e �
6. Water Valves
c A 9 FL-0 AV K
7. Fire Hydrants
G�4 P ��o AV 1C
8. Sewer Piping
GA P FJ-0 j\/APC-0
9. Sewer Fittings
Gi41� LLD Pc d
NOVMEBER 2023 SECTION 00 41 00
2024 HERBERT WALKUP PIPELINE REPLACEMENT PROJECT BID FORMS
5
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NOVMEBER 2023 SECTION 00 41 00
2024 HERBERT WALKUP PIPELINE REPLACEMENT PROJECT BID FORMS
BIDDER'S GENERAL INFORMATION:
The Bidder shall furnish the following information. Additional sheets shall be attached as required.
Failure to complete Item Nos. I through 7, at the time of bid submittal will cause the bid to be non-
responsive and may cause its rejection. Bidders shall submit Item Nos. 8 and 9 if requested by the
OWNER prior to award of contract. No award will be made until all of the Bidder's General
Information (i.e., Items I through 7, inclusive and Items 8 and 9, if requested) is delivered to and
accepted by the OWNER.
(1) Contractor's Name and Address:
X4AaI
(2)
C.OwSSfVCnO" , Z^c.
(3) Contractor's Preferred Email Address:
(4) Contractor's License: Primary Classification A,
State License No. 358835 Expiration Date: a I aSl a`5
Supplemental Classifications held, if any: NAZ .
Name of Licensee, if different from (1) above:
(5)
Name of person who inspected site or proposed Work for your firm:
nspec
A4errti
Name: v;no.e.erDate of Inspection: u115/a3
(6)
Name, address, and telephone number of surety company and agent who will provide the
required bonds on this contract: Greet Amen 244 V &4&p sro 361 rev 0
aot e. Yi"slaecT crnc.nnwYl Ox Y5arLoayyrrrryy
Af.C^T
revp. STE sip w&Iwvd-Cre*%K CA 9YS97 kovs n4or l704,
C� 06uS Tws 6t. I
gro1G<.r
M a.wna.sero yntr-lwlce "5 flee+ yoe ,< 9&� h Rd Ti..cKson CA 956 •f a,
ft0i Yta.ne&Ss Qaop aw ass I
(7)
Complete the following forms:
a) "Non -collusion Declaration"
b) Iran Contracting Act Gertrtoation
c) Public Works Contractor Registration Certification
d) Contractor's Certificate Regarding Workers' Compensation
e) Bid Bond
NOVMEBER 2023 SECTION 00 4100
2024
HERBERT WALKUP PIPELINE REPLACEMENT PROJECT BID FORMS
7
(8) Listthree projects completed as of recent date involving work of similar type and complexity:
Name, address, telephone
Pro'ect
Contract Price
# of OWNER
1. a.o.1� 00�/
STPV 0
B,Soo
3�976/634. 51
tA75. ewdoe. eresv or,
WakuGne
S,+h 1aKG Tn.ho Gi CA
R6plaae,.+u i
Adrhn CG Les, PE (53o�Sv3 C35$
2. ao 1p' N-rpvo
Wwtuii4e
4-765Gi318,78
wim
T 10ro ren u.+s
6'4eve T-, Qa 471-
3.aoa3 61cwK t;ert
STP�D
wwierl,'ne.
�j, 6561796. yl
I.'t"2s Meoww C- eV- pr.
to
-50 +" 1w,Ke Tahoe
Traver Co o l idge PE C3o) sg34 a 78
4' SMD 3
Lacer la. iY. .�;ntcnn�
Ri9i on.Vl Swc`'
51600OS33.91
W.v T Sc ucll
5. is C. Street T �Owd-
G;+ o G eeK
6evr { sun+ onw:q
11 169, 460. s3
Fry K w4j+~s Jw
(8) The experience resume of the person who will be designated chief construction
superintendent or on -site construction manager.
(9) A financial statement,references, and other information, sufficiently comprehensive to penult
an appraisal of Contractor's current financial condition. The financial statement shall be in
accordance with Section 00 20 00, Part 3.01.D.
NOVMEBER 2023 SECTION 00 41 00
2024 HERBERT WALKUP PIPELINE REPLACEMENT PROJECT BID FORMS
a
NONCOLLUSION DECLARATION TO BE EXECUTED
BY
BIDDER AND SUBMITTED WITH BID
The undersigned declares:
l am the President
making the foregoing bid -
(Position) of Vinciguerra Construction, Inc. (Firm), the party
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 arty 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 I€abit ity 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.
l 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 anDcceinber 8,2021date], at Jackson teity],
California (state].
Signature of Declarer
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 An}ador
T. PO=R
Notary Public - California
Amadar County_
(Seal) Commis5ion x 2450965
O"y Comm. Expires Jkjn 20, 2027
Subscribed and sworn to (or affirmed) before me
This 8th day of December 20 23
Austin Vinciguerra
(name of signor)
proved to me on the basis of satisfactory evidence
to be the person who appeared before me.
Signature of Notary
NOVMEBER 2023 SECTION 00 41 OD
2024 HERBERT WALKUP PIPELINE REPLACEMENT PROJECT BID FORMS
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NOVMEBER 2023 SECTION 00 41 00
2024 HERBERT WALKUP PIPELINE REPLACEMENT PROJECT BI❑ FORMS
10
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 an 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: C -
Printed Name: v5'c: n 'V, AC-4 c V e r-
Title: Pre-S ; de,,&
Firm Name: VI A ce �q v C rfz^.
Date: I a r 15/a3
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.
NOVMEBER 2023 SECTION 00 41 00
2024 HERBERT WALKUP PIPELINE REPLACEMENT PROJECT BID FORMS
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NOVMEBER 2023 SECTION 00 41 00
2024 HERBERT WALKUP P;PELINE REPLACEMENT PROJECT BID FORMS
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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 httD:llwww.dir.ca.govlPublic-
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.1
Name of Bidder: Vi n r-i' J
VC4Y"vl- CvnStruG-r►�D,1r
DIR Registration Number: 100006A434 8
❑IR Registration Expiration: 6 / 3a/.;1 4
Small Project Exemption': Yes or -No
Unless Bidder is exempt pursuant to the small project exemption, Bidder further acknowledges:
1. Bidder shall maintain a current ❑IR 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 �, c i verr
Signature G
Name and Title A vs'r► n
Dated I a/115/a3
1 If the Project is exempt from the contractor registration requirements pursuant to the small project exemption under Labor Code
Sections 1725.5 and 1771.1, please mark "Yes" in response to "Small Project Exemption:'
NOVMEBER 2023 SECTION 00 41 00
2024 HERBERT WALKUP PIPELINE REPLACEMENT PROJECT BID FORMS
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NOVMEBER 2023 SECTION 00 49 00
2024 HERBERT WALKUP PIPELINE REPLACEMENT PROJECT BID FORMS
14
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 �' +�verl�o` C n^5 Vrvc-C3v7 / S4 c.
Signature C-
Name and Title A Vs-r"i n v" n C- jVetrr.-
❑ated )A II SIA3
NOVMEBER 2023
2024 HERBERT WALKUP PIPELINE REPLACEMENT PROJECT
SECTION 00 41 00
BID FORMS
15
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NOVMEBER 2023 SECTION 00 41 00
2024 HERBERT WALKUP PIPELINE REPLACEMENT PROJECT BID FORMS
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BID BOND
KNOW ALL MEN BY THESE PRESENTS,
That Vincivuerra Construction, Inc. as Principal, and
Great American Insurance Company as Surety, are geld and firmly
bound unto SOUTH TAHOE PUBLIC UTILITY DISTRICT, hereinafter called "OWNER," in the sum
of Ten ( It}) percent of toil amount of bid
total amount of Bid)
dollars, (Not less than 10 percent of the
for the payment of which sum, well and truly to be made, we bind ourselves, our heirs, executors,
administrators, successors, and assigns, jointly and severally, firmly by these presents.
WHEREAS, said Principal has submitted a Bid to said OWNER to perform the WORK required
under the bidding sphedule,(s) of the OWNIER's Contract Documents entitled: 2024 Herbert Walkup
Pipeline Replacement Project.
NOW, THEREFORE, if said Principal is awarded a contract by said„OWNER and, within the time
and in the manner required in the "Notice Inviting Blds".and the "Instructions to Bidders" enters into
a written Agreement on the form of agreement bound With said Contract Documents, furnishes the
required certificates of insurance, and furnishes the required Performance Bond and Payment
Bond, then this obligation shall be null and void, otherwise it shall remain in full force and effect.
FURTHERMORE, 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 such changes.
In the event suit is: brought upon this bond by said OWNER and OWNER prevails, Surety shall pay
all costs incurred by said OWNER in such suit, including attorney's fees and costs..
SIGNED AND SEALED, this 8th day of. December 20 23
Austin Vinciguerra 1 Vinciguerra Construction, Inc.
(Principal)
cam f 1 President
(Signature for Principal) (Title)
Surety Greer A mPr;[an Insurance Co.
Robert Nana ero
��.Y Attorney -In —Fact
(Signat e r Surety} (Title}
NOVMEBER 2023
2024 HERBERT WALKUP PIPELINE REPLACEMENT PROJECT
SECTION 00 41 00
S1b FORMS
17
Surety's. address in California for service of process:
Great American Insurance Company
1255 Treat Blvd., Suite 810
Walnut Creek, CA 94597
A notary .pubtic or other ofi'icer 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 Amador 3
On December 8, 2023 before me, T. Portzer, Notary personally
appeared Robert Manassero who proved to the on the basis of satisfactory
evidence to be the person(s) whose name(s) islare subscribed to the within instrument as the
representative of the Surety acknowledged to me that helshe executed the same in his/her
authorized capacity, arid subscribed the name of the Great American Insurance Co. (Surety)
(hereto and his/her own name as the'representative of the Surety.
t certify under penalty of perjury under the laws of the State of California that the foregoing
paragraph is trite and correct.
WITNESS m nd and official seal_
Notary Public in and fo aid State
(SEAL) NotarT. POR77ER
y Psib0c - California
x Amador County
y Commission k 2450965
My Umm. Expires Jun Z0, M7
Commission expires_ June 2G, 2027
NOTE: A copy of the Power -of Attomey to local representatives of the bonding company must
be attached hereto.
NQVMEBER 2023 SECTION 00 41 00
2024 HERBERT WALKUP PIPELINE REPLACEMENT PROJECT BID FORMS
i8
GREAT AMERICAN INSURANCE COMPANYO
Administrative Office: 301 E 4TH STREET ® CINCINNATI, OHIO 45202 ® 513-369-5000 ® FAX 513-723-2740
The number of persons authorized by
this power of attorney is not more than ONE
No. 0 21462
POWER OFATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That the GREATAMERICAN NSURANCE COMPANY, a corporation organized and existing under
and by virtue of the laws of the State of Ohio, does hereby nominate, constitute and appoint the person or persons named below, each individually if more than
one is named, its true and lawful attorney -in -tact, for it and in its name, place and stead to execute on behalf of the said Company, as surety, any and all bonds,
undertakings and contracts of suretyship, or other written obIigations in the nature thereof; provided that the liability of the said Company on any such bond,
undertaking or contract of suretyship executed under this authority shall not exceed the limit stated below
Name Address Limit of Power
ROBERT MANASSERO JACKSON, CALIFORNIA $100,000,000
This Power ofAttorney revokes all previous powers issued on behalf of the attomey(s)-in-fact named above.
IN WITNESS WHEREOF the GREAT AIN4FRICAN INSURANCE COMPANY has caused these presents to be signed and attested by its appropriate
Officers and its corporate seal hereunto affixed this 28TH day of JULY 2020
Attest
GREATAMERICAAi I7�SURANCE COMPANY
Jll
Assistant Secretary ptsislonat Senior vice President
STATE OF OHIO, COUNTY OF HAMILTON - ss: MARK VICnRIQ (877-377-2405)
On this 28TH day of JULY 2020 before me personally appeared MARK VICARIO, to me known,
being duly sworn, deposes and says that he resides in Cincinnati, Ohio, that he is a Divisional Senior Vice President of the Bond Division of Great American
Insurance Company, the Company described in and which executed the above instrument; that he knows the seal of the said Company; that the seal affixed to the
said instrument is such corporate seal; that it was so affixed by authority of his office under the By -Laws of said Company, and that he signed his name thereto
by like authority.
' =:
SUSAN A KOHORST
a�
Notary Pubhc
`'� c
State of Ohio
My Comm. Evires
Aay 18, 7.025
This Power of Attorney is granted by authority of the following resolutions adopted by the Board of Directors of GreatAmerican Insurance Company
by unanimous written consent dated June 9, 2008,
RESOLVED: That the Divisional President, the several Divisional Senior Pice Presidents. Divisional Pice Presidents and Divisonal Assistant 1 rce
Presidents, or any one of them, be and hereby is authorized, from time to time, to appoint one or more Attorneys -in -Fact to execute on behalf of the Company, as surety, any and all bonds, undertakings and contracts ofsuretyship, or other written obligations in the nature thereof, to prescribe their respective duties and
the respective limits of their authority: and to revoke arty such appointirtent at any time.
RESOLVED FURT F-R: That the Company seal and the signature of any of the aforesaid officers and any Secretary or Assistant Secretary of the
Company may be affaed by facsimile to any power of attorney or certificate of either given far the execution of any bond, undertaking, contract of suretyship,
or other written obligation in the nature thereof, such signature and seal when so used being hereby adopted by the Company as the original signature of such
officer and the original seal of the Company, to be valid and binding upon the Company with the same force and effect as though manually affixed
CERTIFICATION
I, STEPHEN C. BERAHA, Assistant Secretary of Great American Insurance Company, do hereby certify that the foregoing Power of Attorney and
the Resolutions of the Board of Directors of June 9, 2008 have not been revoked and are now in fill force and effect.
Signed and sealed this 8th day of D?ce9teT'
2023
Assistant Secretary
S1029AH (03120)
ACKNOWLEDGMENT OF INSURANCE REQUIREMENTS
This Document Must Be Fully Executed By Contractor
and Submitted With The Bid
The following insurance requirements have been adopted by The South Tahoe Public Utility District
hereinafter designated the "OWNER," and shall be applicable to this Contract.
Insurance Reauirement Summary
The CONTRACTOR shall furnish, prior to Notice to Proceed, Insurance Certificates and
Endorsements as set forth in Section 00 20 00, Part 2.08.1) and Section 00 73 00, Supplementary
Conditions, Part 2.01. No other insurance documents shall be accepted in substitution of, nor in
addition to, those set forth in Section 00 20 00, Instructions for Procurement. Insurance
requirements and coverage will be in accordance with Section 00 73 00, Supplementary Conditions,
Part 2.01.
The CONTRACTOR shall not commence work underthis Contract until all insurance required under
this heading is obtained in a form acceptable to OWNER, nor shall the CONTRACTOR allow any
Subcontractor to commence work on a subcontract until all insurance required of the Subcontractor
has been obtained.
I, A us-ti n V)' n r- q verro` , the P�� de -I —
J {Insert Title)
Of V ►, c� q ves`rv,— Gn•.s cr�c r� on / 'rn C .
.J (Name of Company or Corporation or Owner)
certify that the Insurance Requirements Summary has been read and understood and that as a
material consideration of our bid, we are able to provide the document and coverage specified.
Signature of President, Secretary,
Manager, Owner, or Representative
Date: ) X f 1512,3
NOVMEBER 2023 SECTION 00 41 00
2024 HERBERT WALKUP PIPELINE REPLACEMENT PROJECT BID FORMS
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2024 HERBERT WALKUP PIPELINE REPLACEMENT PROJECT BI❑ FORMS
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CERTIFICATION BY CONTRACTOR'S INSURANCE BROKER
This Document Must be Fuliv Executed By Contractor's,
Insurance Broker and Submitted With the Bid.
Robert Manassero of Manassero Insurance Agency , am an authorized representative of
(individual's name and brokerage name)
The Travelers Property Casualty Company of American , This company is the insurance broker
(Insurance Company)
for Vinciguerra Construction, Inc. ('Contractor").
tContractorj
By my signature below, I hereby attest to the following:
1. 1 have reviewed the insurance requirements for the South Tahoe Public Utility
District's 2024 Herbert Walkup Pipeline Replacement Project ("Project"), including the
requirements set forth in Section 00 73 00, Supplementary Conditions, Part 2.01 of the Contract
Documents.
2. The Contractor is eligible to be insured for the policies necessary to satisfy the
insurance requirements for the Project.
This certification is not intended to be binding of coverage-alij + ao* of modify and/or alter the
terms and conditions of the insurance policies' d to Contractor.
Date: December 8. 2023 - - �•� c
(Signature r2f n►,thaf�zed representative)
for The Travelers Property Casualty Company of America
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 )
y ss.
County of Amador )
on December 8, 2023 before me, T. Portzer, Notary , personally appeared
Robert Manassero , who proved to me on the basis of satisfactory evidence to be the
person(&) 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.
WIT SS my d and fficial seal. T. Porrrm
Notary Public - California
]fA.. Amador County
Commission N 24W65
Notary Public My Comm, Expires Jun 20, 2027
NOVIVIEBER 2023 SECTION 00 41'DO
2024 HERBERT WALKUP PIPELINE REPLACEMENT PROJECT. BID FORMS
21
SECTION 00 75 00
GRANT FORMS
PART1 GENERAL
1.01 SUMMARY
A. Section Includes:
1. To comply with the Contract requirements for Grant Funding, the Contractor
must complete the following forms (attached) and submit them with the Bid:
a. Form 4500-3: DBE Subcontractor Performance
b. Form 4500-4: DBE Subcontractor Utilization
2. To comply with Contract requirements for Grant Funding, the Contractor must
complete the following forms and submit them at the District's request in
accordance with Section 00 20 00, Part 2.06.A:
a. American Iron and Steel Certification
b. Build America, Buy America Certification
c. Certification Regarding Debarment, Suspension, ineligibility and Voluntary
Exclusion
d. Lobbying Forms, only one shall be completed, as applies:
1) Certification Regarding Lobbying, or
2) Disclosure of Lobbying Activities
e. Form 1: DBE "Good Faith" Effort List of Subcontractors Solicited
f. Form 5: Summary of Bids Received — DBE and non -DBE.
3. To comply with Contract requirements for Grant Funding, the Contractor must
complete the following forms and submit them at the District's request
following award of the proiect.
a. Certification of Non -Segregated Facilities
b. Drug -Free Workplace Certification
c. Non -Discrimination Clause
d. Form 4500-2: DBE Subcontractor Participation Form
B. The certification requirements included herein are described fully in
Section 00 74 00, Grant Conditions.
NOVEMBER 2023 SECTION 00 75 00
2024 HERBERT WALKUP PIPELINE GRANT FORMS
REPLACEMENT PROJECT 1
Water Boards Disadvantaged Business Enterprise (DBE) Program
DBE Subcontractor Performance Form
This form is intended to capture the DBE' subcontractoeedescnption of work to be performed and the price of
the work submitted to the prime contractor. A Financial Assistance Agreement Recipient must require its prime
contractor to have its DBE subcontractors complete this form and include all completed forms in the prime
contractor's bid or proposal package,
Subcontractor Name MAPCA SURVEYS, INC. I Project Name i
2024 Herbert -Walkup Pipeline Replacement
Bid I Proposal No. I Assistance Agmemem ID No, ff mown) Pcird of Contact
Guillermo E. Carey I
Address
Telephone No. 7Email Address
-
Prime Contractor NameuinglFundirg Entity
Vinciguerra ConstructionWSRF and STPUD
Contract Item Description of Work Submitted from the Prima Contractor Involving Price of Work
Number Construction, Services, Equipment or Supplies Submitted to the
Prima Contractor
Fir N3 Construction Surveying $27,650.00
DBE Cedified By: `=9F/ SBA Meets/exceeds EPA certification standards?
Other. _ 1 � NO 11Unknown "
'A DBE is a Disadvantaged, Minority, or Woman Business Enterprise that has been certified by an entity from which EPA
accepts certifications as described In 40 CFR 33.204-33.2015 or certified by EPA. EPA accepts certifications from entities
that meet or exceed EPA certification standards as described in 40 CFR 33.202.
2 Subcontractor is defined as a company, firm, joint venture, or individual who enters into an agreement with a contractor
to provide services pursuant to an award of financial assistance.
FORM 4500-3 JOSE Subcontractor performance Form)
NOVEMBER 2023
2024 HERBERT WALKUP PIPELINE
REPLACEMENT PROJECT
SECTION 00 75 00
ORANTFORMS
21
I certify under penalty of perjury that the forgoing statements are true and correct. Signing this form does not
signify a commitment to utilize the subcontractors above. I am aware that in the event of a replacement of a
subcontractor, I will adhere to the replacement requirements set forth in 40 CFR Part 33 Section 33.302 jcj.
Prime Contractor Signature Print Name
C -
Title Date •1
Subcontractor Signature Print Name
j 0—
Guillermo E. Carey
+� Title Date
President 12/1512023
The public reporting and record keeping burden for this collection of information is estimated to average three (3) hours per
response. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and
any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to
the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW,
Washington, D.C. 20460. Do not send the completed form to this address.
FORM 4500-3 (06E Subcontractor Performance Form)
NOVEMBER 2023 SECTION 00 75 00
2024 HERBERT WALKUP PIPELINE GRANT FORMS
REPLACEMENT PROJECT 22
9
Water Boards Disadvantaged Business Enterprise (DBE) Program
DBE Subcontractor Utilization Form
This form is intended to capture the prime contractors actual and/or anticipated use of identified certified DBE'
subcontractors and the estimated dollar amount of each subcontract A Financial Assistance Agreement
Recipient must require Its prime contractors to complete this form and include it in the bid or proposal package.
Prime contractors should also maintain a copy of this form on file.
Prime Gontracior Name I Project Name IlI
Vt �ipvu'P�� C4nSTruc Ta•I I=nc. 4a.paLi liofbsr+W IkiaP
Ntd I P o0339911 No. I Assistance Agreemen ID No. (if known) FPoint of Contact' - I
I have identified potential DBE certified subcontractors. Q NO
If yes, please complete the table below. If no, please explain:
Subcontractor Namel
Company Name Company Address/Phone /Eman
MA pGA
s ,,, Y31 z
Gam¢ Q n.a-cos vr...ys. curt
—continue on back ffneeded—
Fstlmated Cummtay
DBE
Ntrount
Amon
CerUFed7
$27,650.00
- -
I
J
sA DBE is a Disadvantaged, Minority, or Woman Business Enterprise that has been certified byan entity from which EPA
accepts certifications as described in 40 CFR 33.20433.201E or certified by EPA EPA accepts certifications from entities
that meet or exceed EPA certification standards as described in 40 CFR 33.202.
'Subcontractor is defined as company, firm, joint venture, or individual who enters into an agreement with a contractor
to provide services pursuant to an award of financial assistance.
FORM 450Q4 (OBESubcontructor UbRzation Ford
NOVEMBER 2023 SECTION 00 75 00
2024 HERBERT WALKUP PIPELINE GRANT FORMS
REPLACEMENT PROJECT 23
I certify under penalty of perjury that the forgoing statements are true and correct. Signing this form does not
signify a commitment to utilize the subcontractors above. I am aware that in the event of a replacement of a
subcontractor, I will adhere to the replacement requirements set forth in 40 CFR Part 33 Section 33.302 (c).
Prime Contractor Signature Print/Name
Title Date �f
0-de.F- - - 1 ;I!,' 15 /6'3
The public reporting and record keeping burden for this collection of information is estimated to average three (3) hours per
response. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and
any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to
the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1240 Pennsylvania Ave., NW.
Washington, D.C. 20460. D❑ not send the completed form to this address.
FORM 4500-4 (DOE Subcontractor Utilization Form)
NOVEMBER 2023
2024 HERBERT WALKUP PIPELINE
REPLACEMENT PROJECT
SECTION 00 75 00
GRANT FORMS
24