ATTACHMENT6 BID/BIDDER CERTIFICATION SHEET

Invitation For Bid IFB Number 04A5391

Page 1 of 2

Only an individual who is auth01ized to bind the bidding finn 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 ce1tifies compliance with all the requirements of this bid document. The

signature below authorizes the verification of this ce1tification. E. The signature and date affixed hereon certifies that this bid is a finn offer for a 90-day period.

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

l. Company Name 2. Telephone Number

L.oru~ ·lf __ \_.~C, Y C. (J 2..,;z.. -~~I "2...

2b. Email Address \..0\~\..,'""'\ _\ 2 \...o I\J\: .. fc:.lJcL""C \ZU , C..D ('....... 3. Address

t...\ SD , rc:.c..-~-1v ()lo\.~ W C½,\ ~~~ CJ\ C\45"<,:;' ~ I I

Indicate your organization type: 4. D Sole Proprietorship I 5. D Partnership

2a. Fax Number

c z...~·-z -??sl/0

I 6. [jl!, Corporation

Indicate the applicable employee and/or corporation number:

7. Federal Employee ID No. (FEIN) b<t-OY0:?.406 I 8. California Corporation No.

Indicate the Department of Industrial Relations information: 9. Contractor Registration Number \0 000 ! l 09 Q Indicate applicable license and/or certification information: 10. Contractor's State Licensing

Board Number

12. Bidder' Name (Print)

L,()~\,,T :fo\¼N~ 1J

11. PUC License Number CAL-T-

13.~ tle

-Vu...\..tl''

16. k you cer/ified with the Department of General Services, Office of Small Business and Disabled Veteran Business Enterp ·se Se ices (OSDS) as: a. Small Business Enterprise Yes I]] No D If yes, enter certification nut\~?5'

b. Disabled Veteran Business Enterprise Yes D No [)o' 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 "Yes".

Date application was submitted to OSDS, if an application is pending:

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 (I) Hour

2 500 One ( I) Hour

3 1000 One (1)

Hour

4 100 One (1) Hour

5 3500 One ( I) Hour

One (1) 6 350

Hour

7 6000 One ( I)

Hour

8 600 One ( 1) Hour

One ( I) 9 2,500

Hour One (I) 10 1850

Hour

11 23000 One (1) Linear Foot

12 2600 One (1)

Linear Foot

13 8000 One (1)

Linear Foot

14 8000 One (1) Linear Foot

One (1) 15 4500

Linear Foot One (I)

16 2000 Linear Foot

17 6500 One (I)

Linear Foot

18 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 (24-strand, SM)

Fiber Optic Cable - Drop Installation (72-strand, SM)

Fiber Optic Cable - Drop Installation ( 144-strand, SM)

Four Inch (4") Conduit with Inner-duct Installation

Outdoor Network Straight Through Data Cable Installation

Agreement Number 04A5391 Page 1 of 4

UNIT PRICE TOTAL (Price Per Unit of (Estimated Quantity

Measure) X Unit Price)

$ ,~ 1.1 ,

$ ~'JO om -$ l¥l.- - $ 1~ l , 000 $ I Ll i - $ \ L\Z-. Q(Y) -$ ZDC::,. $ m .<to ~ $ iOr-- $ c~I)? rnn --$ 1s-,- $

I · ~

S2, ?SC -$ ~~~ $ 60/.0(){) $ ·13q - $ &> '4.nn . $ )111-) - $ l/J~. ooc -

i-/tD .,

~8.ow $ $

$ ·z ~g. $ s1 ,·soo $ ')Q - $ 0--) 'f; z l ttJ( $ 3 .... $ z~ ooo $ 4- $ ;??, '[)Of) -

I

$ s- $ zz.&Jo-$ i- $ 12 ODO

-

$ loZ - $ 10 403; Doc $ -3- $ 30. /X)Q .

SUB TOT AL PAGE I (Items 1-18) '7so -$ 'I, 33 / I ~

---------.·---------

ATTACHMENT 1

ITEM ESTIMATED UNIT OF NO. QUANTITY MEASURE ITEM

19 130 Each Ethernet Edge Switch Installation (Copper)

20 90 Each Ethernet Edge Switch Installation (Fiber)

Fiber Patch Panel Installation 21 130 Each <l2-nor0

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

23 35 Each Fiber Optic Splice Enclosure Installation

24 90 Each Traffic Rates Fiber Optic Pull Box Installation

25 35 Each Fiber Optic Splice Vault Installation

26 1800 Each Perfom1 Field Fiber Optic Fusion Splice and OTDR Testing

27 3 Each Router Replacement (Hub)

28 3 Each Ethernet Switch Replacement (Hub)

29 2 Each Field Aggregation Switch Replacement

30 10 Each LED EMS Sign Panel Replacement

31 10 Each EMS Control Panel & Assembly Replacement

~ +G :6eeh VMS Sige P!lf!el eml Cene-eller Asseml:Jly Repleeement

;; +G Beel¼ VMS CeHtrel PeHel & Asseffll:Jly RepleeerAeHt

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 Information Message Sign Panel Replacement

38 4 Each Information Message Sign Controller Replacement

39 5 Each Model 334T Controller Cabinet Replacement CCTV

Agreement Number 04A5391 Page 2 of 4

UNIT PRICE TOTAL (Price Per Unit of (Estimated Quantity

Measure) X Unit Price)

$ 3'100 ,.

$ '-l03 1000 -

$ z C\qo .... $ ~9 -100

~ _..,,. $ l O ~~ -- $ i40. }LU) $ --5/\)3 .... $ qz I '(05' $ \.Sl-0-- $ -S'Z 1500 ..

-$ zsz. oro $ -Z.'8:DO

$ )l 10CO - $ -.53~ coo ~ $ 4-z_ - $ 7..5 bOO $ Z3,0oo $ b9 noo·-

.--'

;J1 oot> -$ Z:S 00D $

$ zz.5 go $ 4.'iohO -tS"i 400

./

JSL/ [()O $ $ -$ Z<?oo -- $ 28':{)()0 -£ -- £ --£ - £

$ /1.CJOmn ,,.

$ IWJ ooo ..,

$ o·~z& ..,

$ 33i .~D4-$ rd) {){Y)

,.. $ U?t,a:JO -

$ 1./0.~ZD .... $ !lo-:3 z..oD . I

f), I, lcaJ / -$ $ -3b1 t./CO $ 10, ~zo- $ SJ,bCO-

SUBTOTAL PAGE 2 (Items 19-39) $ 2'14\~09 -

ATTACHMENT 1

ITEM ESTIMATED UNIT OF NO. QUANTITY MEASURE ITEM

40 150 Each Traffic Rated Pull Box and Lid Replacement (up to number 6 pull box)

41 2 Each Lane Use Sign Replacement

42 4 Each Antenna Replacement (HAR)

43 4 Each Cabinet Assembly Replacement (HAR)

44 4 Each Chassis Replacement (HAR)

45 4 Each Transmitter Replacement (HAR)

46 4 Each Digital Recorder-Player Module Replacement (HAR)

47 4 Each Power Supply Module Replacement (HAR)

48 4 Each AC Rack Replacement (HAR)

49 4 Each Battery Backup System Replacement (HAR)

One ( I) 50 l 10

Linear Foot CCTV Camera Replacement (PTZ)

51 25 Each CCTV Camera Replacement (Fixed)

52 90 Each CCTV Camera Controller Replacement

One ( I) 53 17000 CCTV Camera Cable Replacement

Linear Foot

54 90 Each CCTV Video Encoder Unit Replacement

55 20 Each Router Replacement (Field)

56 10 Each Type 3 Service Cabinet Replacement

57 10 Each Telecommunication Distribution Cabinet Replacement (Type B)

58 5 Each Model 334L Controller Cabinet Replacement (TOS)

59 I Lump Sum Storm Water Pollution Control Plan

Agreement Number 04A5391 Page 3 of 4

UNIT PRICE TOTAL (Price Per Unit (Estimated Quantity

of Measure) X Unit Price)

$ ·z.4 LJO ,,

$ -6 t:,<a mo ,.-

-$ ~qro $ 'ls ,~oo-$ J3. 1..no

,., $ Z.fl I LDO -

-$ it:;, 300 $ z,<,,2Do --$ 6&'to $ 2~,Z-00 -$ ~~lOD- $ 3Z, oOO

-- S9,000 -$ l~Y.X) $

~~U) ,,..

$ $ l6 1./l/O . $ 3.~l.JD.- $ l!J~3(d)

.. -

$ lo, )t0 ,-

$ ' cf./. '100 -

5',~oo (:;oS:oco -$ $

-z.~ --$ $ k,S' l'.Xl::) -

Zr.3CC/- ZdJ,r'IO ,,

$ $

S.;;'D - q3 6DD·-$ $

/ '""Cb .

)3 - too __,, $ $ /:; .>, - --$ ;J,$"/f $ I}()_ --.?hO -

$ kJ,{1)0 $ 0, cm -$ ~ ::IJO .-- $ 35: coo--

qooo -- '-IS-, cw --$ $ . $ ~DOD - $ - .-0.000

SUBTOTAL PAGE 3 (Items 40-59) $ /C/19, 010--

ITEM NO.

60

61

62

63

64

65

66

Agreement Number 04A5391 Page 4 of 4

ATTACHMENT 1 UNIT PRICE

ITEM ( Price Per Unit of Measure)

Miscellaneous 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 l (Items 1-18)

SUBTOTAL PAGE 2 (Items 19-39)

SUBTOTAL PAGE 3 (Items 40-59)

SUBTOTAL PAGE 4 (Items 60)

FINAL SUBTOTAL (Items 61-64)

Maximum allowable expenditure for 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. TIDS 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 PROPOSAL

(2) IN CASE OF DISCREPANCY BETWEEN THE UNIT PRICE AND THE TOTAL SET FORTH FOR A UNIT BASIS (Items 65 + 66) ITEM, THE UNIT PRICE SHALL PREVAIL.

TOTAL (Estimated Quantity

X Unit Price)

$610,000.00

$ 4331 ?5D . ' $ 2, r;q /, f.id} --$ t? --I. q179, O?l $610,000.00

$ q l&,lo z. h (. zq­qo

$ qi,i, I l ~ Z, --$ ltJ, t:iii,<i? 9}~

Attachment 2 Agreement 04A5391

Page 1 of 1 STATE OF CALIFORNIA DEPARTMENT OF TRANSPORTATION SUBCONTRACTING PROVISIONS/LIST 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

..,\) fc ~ Tni'C-N TePffT(., ~v??l--l,\ jc.'i10C 13947.. 'ft.}U9 f},Jf2.. Ula:T (Y\

?L.~ ~ ~'° r-J CA~ q ~ 5b er-

t,>0 \).L '? f£ ~ltfOMI~ \ q C\ ~ \,\ zc b ).\-\}) ~~ I.ti~ Lv\~ Ml'l., L~O c'4- ClS-1,9 -i-,

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

TTp·~c Co N'ri2 oL

·-r~L.tC,orn.rnu ruse. ATcronJ

FcT(sF/L

\Ufc..CofY'lfr\ ~QU.Tf)fhJ:.-w~

cc.-·TV

~

STATE OF CALIFORNIA• DEPARTMENT OF TRANSPORTATION

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

/"\lld\.;J 11 1 lt::l ll u

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 NAME

~ ,1)1 \,o 'fV b Tr-~\.;~ r:Tf2zs::e,__, CONTRACTOR'S BUSINESS ADDRESS

.:5'.o. 1f.ClhJI) l.Di"""u l1\ CONT ACT PERSON

(l

CONTRACT DOLLAR AM'2}J~ T

\o,ec,u.~ l .!.3:!..-DATE

1-/'(-lt' STATE ZIP CODE c~ q '-ls-s--o

l,u f.\. ~ T ::To\~,~ ~ 0 BUSINESS PHONE (fldl ) "2- :S-z_ - -~ ~ / c

FAX NUMBER

()tll ) z,;' z -'ts 040 EMAIL ADDRESS

LJA-t, T ;re Lo NI:- lt l[cnz.rt . LCYh

l\)

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

C\.., ..-- - --...,.,. \IL.{). q:;rc., CoN '1cDl, ~\~ ~ ~f<..i--C.. 3\..,~ 1 >.ZG.')l 2-'-'\l\ · I tst.l \ '-l00t1 -z.. 9~D_,ooo /a)/

1 V I

-S'S-l .... oCir.~J:c~\ - ~ \,,rTT:J~_:re..Dtr> ~ ')q '1 - c-tD~ 4 I rn l\\~a:..A "\ ~ uv~lli::-'1L JC\ q 6 ~ 2

5/D, qq, Z_Q . &o ·-/. ~ l, ~Sc-~ 6 0· 1

~~v l,4qD,99l~ ~ PART C - FOR CAL TRANS USE ONLY (Verification Completed by Civil Rights, Office of Business and Economic Opportunity):

PRINT VERIFIER'S NAME AND TITLE I SIGNATURE IDATE CIVIL RIGHTS STAMP OF APPROVED

DBE PARTICIPATION D YES ( %) ONO