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ATTACHMENT "A"
IFB 21-04 ROADSIDE AND TRANSIENT MAINTENANCE RE -BID
YOUR BID* SIGNATURE AUTHORIZATION
NAME OF COMPANY (BIDDER):
BUSINESS ADDRESS:
TELEPHONE:
CONTACT PERSON:
CELL PHONE: FAX:
EMAIL ADDRESS:
A. I hereby certify that I have the authority to submit this Bid to the City of Palm Springs for
the above listed individual or company. I certify that I have the authority to bind myself/this
company in a contract should I be successful in my Bid.
PRINTED NAME AND TITLE
SIGNATURE AND DATE
B. The following information relates to the legal Bidder listed above, whether an individual or a
company. Place check marks as appropriate:
If successful, the contract language should refer to me/my company as:
An individual;
A partnership, Partners' names:
A company;
A corporation If a corporation, organized in the state of:
My tax identification number is:
Please check below IF your firm qualifies as a Local Business as defined in the IFB:
A Local Business (licensed within the jurisdiction of the Coachella Valley). Copy of current
business license is required to be attached to this document.
ADDENDA ACKNOWLEDGMENT:
Acknowledgment of Receipt of any Addenda issued by the City for this IFB is required by including
the acknowledgment with your bid. Failure to acknowledge the Addenda issued may result in your
bid being deemed non -responsive.
In the space provided below, please acknowledge receipt of each
Addendum: Addendum(s) # is/are hereby acknowledged.
LATE BIDS WILL NOT BE ACCEPTED — NO EXCEPTIONS!
64
IFB 21-04 ROADSIDE AND TRANSIENT MAINTENANCE RE -BID
ATTACHMENT "B"
*THIS FORM MUST BE COMPLETED AND SUBMITTED WITH YOUR BID
CITY OF PALM SPRINGS, CA
CONFLICT OF INTEREST AND NON-DISCRIMINATION CERTIFICATION
Conflict of Interest. Bidder acknowledges that no officer or employee of the City has or shall have
any direct or indirect financial interest in this Agreement nor shall Bidder enter into any agreement of
any kind with any such officer or employee during the term of this Agreement and for one year
thereafter. Bidder warrants that Bidder has not paid or given, and will not pay or give, any third party
any money or other consideration in exchange for obtaining this Agreement.
Covenant Against Discrimination. In connection with its performance under this Agreement,
Bidder shall not discriminate against any employee or applicant for employment because of actual or
perceived race, religion, color, sex, age, marital status, ancestry, national origin (i.e., place of origin,
immigration status, cultural or linguistic characteristics, or ethnicity), sexual orientation, gender
identity, gender expression, physical or mental disability, or medical condition (each a "prohibited
basis"). Bidder shall ensure that applicants are employed, and that employees are treated during their
employment, without regard to any prohibited basis. As a condition precedent to City's lawful capacity
to enter this Agreement, and in executing this Agreement, Bidder certifies that its actions and
omissions hereunder shall not incorporate any discrimination arising from or related to any prohibited
basis in any Bidder activity, including but not limited to the following: employment, upgrading,
demotion or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other
forms of compensation; and selection for training, including apprenticeship; and further, that Bidder
is in full compliance with the provisions of Palm Springs Municipal Code Section 7.09.040, including
without limitation the provision of benefits, relating to non-discrimination in city contracting.
NAME OF BIDDER/VENDOR:
NAME and TITLE of Authorized Representative:
(Print)
Signature and Date of Authorized Representative:
(Sign)
65
(Date)
ATTACHMENT "C"
CITY OF PALM SPRINGS
PUBLIC INTEGRITY DISCLOSURE
(INSTRUCTIONS FOR APPLICANTS)
Who Must File?
Applicants that are NOT a natural person or group of natural people that will be identified on the
application, and seek a City approval determined by a vote of City officials. Examples include
corporations, limited liability companies, trusts, etc. that seek a City Council approval, or an approval
by one of the City's board or commissions.
Why Must I File?
The City of Palm Springs Public Integrity Ordinance advances transparency in municipal government
and assists public officials in avoiding conflicts of interest. The City's Public Integrity Ordinance,
codified in Chapter 2.60 of the municipal code, reflects the City's interest in ensuring that companies
(and other legal entities that are not natural people) doing business in the community are transparent
and make disclosure as to their ownership and management, and further that those companies
disclose the identity of any person, with an ownership interest worth two thousand dollars ($2,000) or
more, who has a material financial relationship with any elected or appointed voting City official, or
with the City Manager or City Attorney.
Note: A material financial relationship is a relationship between someone who is an
owner/investor in the applicant entity and a voting official (or the City Manager or City
Attorney), which relationship includes any of the following:
(1) the owner/investor and the official have done business together during the year prior to the
application,
(2) the official has earned income from the owner/investor during the year prior to the filing of the
application;
(3) the owner/investor has given the official gifts worth fifty dollars ($50) or more during the year
prior to the filing of the application; or
(4) the official might reasonably be anticipated to gain or lose money or a thing of value, based
upon the owner/investor's interest in the applicant entity, in relation to the application's
outcome.
When Must I File?
You must file this form with the Office of the City Clerk at the same time when you file your application
for a City approval determined by a vote of City officials, whether elected or appointed.
What Must I Disclose?
A. The names of all natural persons who are officers, directors, members, managers, trustees,
and other fiduciaries serving trusts or other types of organizations (attorneys, accountants,
etc.).
Note: (1) only trusts or other organizations that are not the fiduciaries, (2) if a second entity that is not
a natural person serves the applicant entity (e. g., as a member of an applicant LLC), then all officers,
directors, members, managers, trustees, etc., of the second entity must be disclosed).
B. The names of persons owning an interest with a value of two thousand dollars ($2,000) or
more who have a material financial relationship with an elected or appointed City official who
will vote on the applicant's application, or with the City Manager or City Attorney.
PENALTIES
Falsification of information or failure to report information required to be reported
may subject you to administrative action by the City.
*There are some additional supplementary instructions with an example following the form
should you need further clarification.
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PUBLIC INTEGRITY DISCLOSURE
APPLICANT DISCLOSURE FORM
1. Name of Entity
2. Address of Entity (Principle Place of Business)
3. Local or California Address (if different than #2)
4. State where Entity is Registered with Secretary of State
If other than California, is the Entity also registered in California? ❑ Yes ❑ No
5. Type of Entity
❑ Corporation ❑ Limited Liability Company ❑ Partnership ❑ Trust ❑ Other (please specify)
6. Officers, Directors, Members, Managers, Trustees, Other Fiduciaries (please specify)
Note: if any response is not a natural person, please identify all officers, directors,
members, managers and other fiduciaries for the member, manager, trust or other entity
❑ Officer ❑ Director ❑ Member ❑ Manager
[name]
❑ General Partner ❑ Limited Partner ❑ Other
❑ Officer ❑ Director ❑ Member ❑ Manager
[name]
❑ General Partner ❑ Limited Partner ❑ Other
❑ Officer ❑ Director ❑ Member ❑ Manager
[name]
❑ General Partner ❑ Limited Partner ❑ Other
.:
7. Owners/Investors with a 5% beneficial interest in the Applicant Entity or a related
entity
EXAMPLE
JANE DOE
50% ABC COMPANY, Inc.
[name of owner/investor]
[percentage of beneficial interest in entity
and name of entity]
A.
[name of owner/investor]
[percentage of beneficial interest in entity
and name of entity]
B.
[name of owner/investor]
[percentage of beneficial interest in entity
and name of entity]
C.
[name of owner/investor]
[percentage of beneficial interest in entity
and name of entity]
D.
[name of owner/investor]
[percentage of beneficial interest in entity
and name of entity]
E.
[name of owner/investor]
[percentage of beneficial interest in entity
and name of entity]
I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF
CALIFORNIA THAT THE FOREGOING IS TRUE AND CORRECT.
Signature of Disclosing Party, Printed Name, Title Date
City of Palm Springs, CA.
Business Disclosure Supplementary Instructions
In an effort to ensure we capture the required business entity information in accordance with the attached
instructions, we provide you these supplementary instructions to clearly identify the required information, and
the format the information should be provided.
If you, as the applicant, are a business entity (i.e. a corporation or limited liability company), and it is also
comprised of other business entities as its members or having a financial interest, all other such business
entities must also be disclosed, including those entities other business entities, if any.
Ultimately, the City's disclosure document (attached) requires a listing identifying all natural persons having
any financial interest over 5% of the business entities (and any other business entities comprising your
business entity).
As an example, Applicant is: Acme Brothers, Inc., a California corporation, whose officers are: John Doe,
Jill Doe, and Jay Doe, which is owned 50% by Acme Brothers, LLC, a California limited liability company,
and John Doe (25% interest) and Jill Doe (25% interest). Acme Brothers, LLC, is managed by Acme Brothers
2, Inc., a California corporation, whose officers are: George Doe, Bill Doe, and Jane Doe, which is owned
100% by Acme Brothers 2, LLC, a California limited liability company, which is managed by George Doe,
with George Doe and Jane Doe having 50% interest each.
The full business entity disclosure in this example would resemble the following:
1. Acme Brothers, Inc., a California corporation
a. Officers: John Doe, Jill Doe, and Jay Doe
b. Ownership:
i. 50% Acme Brothers, LLC, a California limited liability company
ii. 25% John Doe
iii. 25% Jill Doe
2. Acme Brothers, LLC, a California limited liability company
a. Managers: Acme Brothers 2, Inc., a California corporation
b. Ownership: 100% Acme Brothers 2, Inc., a California corporation
3. Acme Brothers 2, Inc., a California corporation
a. Officers: George Doe, Bill Doe, and Jane Doe
b. Ownership: 100% Acme Brothers 2, LLC, a California limited liability company
4. Acme Brothers 2, LLC, a California limited liability company
a. Managers: George Doe
b. Ownership:
i. 50%
70
BID SCHEDULE/PRICING PAGES (IFB 21-04)
PROVIDE ROADSIDE AND TRANSIENT MAINTENANCE RE -BID
Bidders' signed bid and written acceptance by the City shall constitute an agreement and has hereby
agreed to all the terms and conditions set forth in all of the sheets which make up this invitation.
Responding to an Invitation For Bids I F B 21 - 0 4 to provide roadside maintenance for assigned
street routes located within the City of Palm Springs, the undersigned bidder proposes and agrees to provide
the services and work in accordance with the specifications. I/We will accept as full payment therefore the
following amount. NOTE: BIDDERS MUST COMPLETE SCHEDULE "A" AND SCHEDULE "B".
Note: Offeror should state the hourly rate for personnel provided for in this Contract and which will apply to
all work of the Contract. The hourly rate shall constitute the sole basis for payment and include all associated
costs or charges i.e., vehicle, supplies, communication devices, insurance, uniforms, (not all inclusive).
SCHEDULE "A": Rate for Roadside maintenance and transient camp clean-up work based on 8 hours per
day, seven days a week per employee and includes all associated costs for the crew. 'Crew' for purposes of
this bid is defined as Offerors estimate number of employees required to perform the tasks as detailed in the
scope of work for roadside maintenance and transient camp clean-up within the city boundaries.
Title:
Unit Cost
Annual Hours
Annual Cost
Crew:
$
per/hr.
X
2080 hrs.
_
$
Vehicle & Supplies:
$
per/day
X
197 days
=
$
SUBTOTAL:
$
SCHEDULE "B": Rate for Emergency Call Out, based on an estimate of 70 hours annually.
OVERTIME HOURS:
Title:
Unit Cost
Annual Hours
Annual Cost
Crew:
per/hr.
X
X 70 hrs.
_
$
Vehicle & Supplies:
per/day
X
1 day
=
$
SUBTOTAL:
$
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GRAND TOTAL OF BID SCHEDULES "A and B" :
Total Amount in Words:
Total Amount in Figures: $
It is understood and agreed that this Bid may not be withdrawn until sixty (60) days from the date of the
opening thereof, and at no time after award of Bid. Prices to remain fixed for initial contract period of 3 years.
PRICING FOR INITIAL 3 YEAR TERM AND CPI ADJUSTMENTS FOR OPTIONAL RENEWALS:
For the initial three (3) years of the Agreement term, the Unit Pricing shall remain fixed. For optional years
4 and 5, Contractor may request a price adjustment not to exceed the Bureau of Labor Statistic's Consumer
Price Index (CPI) for the LA/Riverside/Anaheim region for the prior 12 month period effective on the
anniversary date. Optional renewal years 4 and 5, and any associated CPI increase, are at the mutual
consent of the City and the Contractor.
Delivery/Schedule for Performance: The bidder must indicate on this Bid Proposal page the time
required for delivery, in number of calendar days, after receipt of order (ARO). Delivery may be a factor
in award of bid and may be cause for rejection, as determined by the City. The work and/or services to
be performed by Vendor pursuant to the purchase order shall be completed by Vendor within time required
for delivery indicated below, unless City approves in writing a revised delivery schedule.
Delivery/ Installation Time: Indicate time in calendar days, required for lead time, delivery and
install after receipt of order (ARO): DAYS (ARO) *Delivery may be a factor in award.
It is understood and agreed that this bid may not be withdrawn for a period of ninety (90) days from the
date of opening thereof, and at no time in the case of the Successful Bidder.
My firm/company is a Local Business (Licensed within the jurisdiction of the Coachella Valley).
NOTE: This page MUST be manually signed.
Certified by:
Signature of Authorized Person
Printed Name
Title
Date
The City is seeking a qualified contractor who has the experience and capability to deliver Roadside
and Transient Maintenance as per the specifications contained herein. A minimum of three (3) references
shall be submitted below with the bid, including contact name and phone number, for projects of a
similar scope to this Invitation for Bids.
1) Name of contractor or agency:
Contact Person:
Brief description of project:
2) Name of contractor or agency:
Contact Person:
Brief description of project:
3) Name of contractor or agency:
Contact Person:
Brief description of project:
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Phone #
ne #
.■.
CITY OF PALM SPRINGS, CALIFORNIA INVITATION FOR BIDS NO. 21-04
PROVIDE ROADSIDE AND TRANSIENT MAINTENANCE RE -BID
NON -COLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND NOTARIZED
AND SUBMITTED WITH BID
STATE OF CALIFORNIA )
) SS
COUNTY OF RIVERSIDE )
The undersigned, being first duly sworn, deposes and says that he or she is
of , the party making the foregoing bid. That the bid is not
made in the interests of, or on the behalf of, any undisclosed person, partnership company, association,
organization, or corporation; that the bid is genuine and not collusive or sham; that the 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; 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 the
bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any
other bidder, or to secure any advantage against the public body awarding the contract of anyone interested
in the proposed contract; that all statements contained in the bid are true; and, further, that 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 thereof, or paid, and will not pay, any fee to any corporation,
partnership, company, association, organization, bid depository, or any other member or agent thereof to
effectuate a collusive or sham bid.
a
Title
Subscribed and sworn to before me this day of , 20_
Notary Public in and for said
County and State
FIDAM.FRM
74
BIDDER'S GENERAL INFORMATION
INVITATION FOR BIDS NO. 21-04
ROADSIDE AND TRANSIENT MAINTENANCE RE -BID
The Bidder shall furnish the following information. Failure to complete all Items will cause the Bid to be
non -responsive and may cause its rejection.
1. BIDDER/CONTRACTOR'S Name and Street Address:
2. CONTRACTOR'S Telephone Number: ( )
Facsimile Number: ( )
1. CONTRACTOR'S License: Primary Classification
State License Number(s)
Supplemental License Classifications
4. Name and Title of person authorized to execute a contract for this company:
5. Surety Company and Agent who will provide the required Bonds on this Contract:
Name of Surety:
Address:
Surety Company
Telephone Numbers: Agent
Surety ( )
6. Type of Contractor (Individual, Partnership or Corporation):
7. Corporation organized under the laws of the State of:
8. List the names and addresses of the principal members of the contractor or names and titles of the principal
officers of the corporation or contractor:
9. Number of years' experience as a contractor in this specific type of work:
10. List the name and title of the person who will supervise full-time the proposed work for this project:
11. Is full-time supervisor an employee contract service ?
12. A financial statement or other information and references sufficiently comprehensive to permit an appraisal
of your current financial condition may be required by the City. *WAIVED*
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CITY OF PALM SPRINGS, CALIFORNIA
IFB 21-04 ROADSIDE AND TRANSIENT MAINTENANCE SERVICES RE -BID
BID BOND FORM
KNOW ALL MEN BY THESE PRESENTS,
That as principal, and
as Surety, are held and contractually
bound unto The City of Palm Springs, hereinafter called the "City" in the sum of:
dollars
(not less than 10 percent of the total amount of the bid)
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, contractually by these presents.
WHEREAS, said Principal has submitted a bid to said City to perform the Work required under the
bidding schedule of the City's Contract Documents entitled:
ROADSIDE AND TRANSIENT MAINTENANCE SERVICES
NOW THEREFORE, if said Principal is awarded a contract by said City, and, within the time and in the manner
required in the "Notice Inviting Bids" 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. In the event suit is brought upon this bond by said
City and City prevails, said Surety shall pay all costs incurred by said City in such suit, including a reasonable
attorney's fee to be fixed by the court.
SIGNED AND SEALED, this day of 120
M
(SEAL AND NOTARIAL By:
ACKNOWLEDGMENT OF SURETY)
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(Signature)
(SEAL)
EAL)
(SEAL) (Principal)
(SEAL) (Surety)
(Signature)
WORKER'S COMPENSATION CERTIFICATE
(AS REQUIRED BY SECTION 1861
OF THE CALIFORNIA LABOR CODE)
am aware of the provisions of Section 3700 of the California 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 said Code, and I will comply with such provisions before commencing the performance of the Work
of this Contract.
Contractor
By
Title
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SUMMARY OF INSURANCE
REQUIREMENTS FOR CITY CONTRACTS
Instructions to Contractors/Vendors/Service Providers:
Prior to commencing any work, all contractors, vendors and service providers shall procure and maintain, at
their own cost and expense for the duration of their contract with the City, appropriate insurance against
claims for injuries to persons or damages to property which may arise from or in connection with the
performance of the work or services. The types of insurance required and the coverage amounts are specified
below:
A. Minimum Scope of Insurance Required
1. General Liability Insurance is required whenever the City is at risk of third -party claims which may
arise out of work or presence of a contractor, vendor and service provider on City premises.
2. Automobile Liability Insurance is required only when vehicles are used by a contractor, vendor or
service provider in their scope of work or when they are driven off -road on City property. Compliance
with California law requiring auto liability insurance is mandatory and can not be waived.
3. Workers' Compensation and Employer's Liability Insurances is required for any contractor,
vendor or service provider that has any employees at any time during the period of this contract.
Contractors with no employees must complete a Request for Waiver of Workers' Compensation
Insurance Requirement form.
4. Errors and Omissions coverage is required for licensed or other professional contractors doing
design, architectural, engineering or other services that warrant such insurance.
B. Minimum Limits of Insurance Coverage Required
Under $25,000 Limits TBD by Risk Manager
Over $25,000 to $5,000,000 $1 Million per Occurrence/$2 Million Aggregate
Over $5 Million
Limits TBD by Risk Manager
Umbrella excess liability may be used to reach the limits stated above.
C. The following general requirements apply:
1. Insurance carrier must be authorized to do business in the State of California.
2. Insurance carrier must have a rating of or equivalent to B++, VII, by A.M. Best Company.
3. Coverage must include personal injury, protective and employer liability.
4. Certificate must include evidence of the amount of any deductible or self -insured retention under the
policy.
5. Contractor's general liability and automobile insurance coverage must be primary and non-
contributory over any insurance the City may maintain, that is, any such City insurance shall be excess
to limits stated in the certificate.
D. Verification of Insurance coverage may be provided by: (1) an approved General and/or Auto Liability
Endorsement Form for the City of Palm Springs or (2) an acceptable Certificate of Liability Insurance
Coverage with an approved Additional Insured Endorsement (see attached) with the following
endorsements stated on the certificate:
79
1. "The City of Palm Springs, its officials, employees and agents are named as an additional insured'
("as respects a specific contract" or "for any and all work performed with the City" may be included in
this statement).
2. "This insurance is primary and non-contributory over any insurance or self-insurance the City may
have" ("as respects a specific contract" or "for any and all work performed with the City" may be
included in this statement).
3. "Should any of the above described policies be canceled before the expiration date thereof, the issuing
company will mail 30 days written notice to the Certificate Holder named." Language such as,
"endeavor to" mail and "but failure to mail such notice shall impose no obligation or liability of any kind
upon the company, its agents or representative" is not acceptable and must be crossed out. See
Example A below.
4. Both the Workers' Compensation and Employers' Liability policies shall contain the insurer's waiver of
subrogation in favor of City, its elected officials, officers, employees, agents and volunteers. See
Example B below.
In addition to the endorsements listed above, the City of Palm Springs shall be named the certificate holder
on the policy.
All certificates and endorsements are to be received and approved by the City before work commences. All
certificates of insurance must be authorized by a person with authority to bind coverage, whether that is the
authorized agent/broker or insurance underwriter. Failure to obtain the required documents prior to the
commencement of work shall not waive the contractor's obligation to provide them.
E. Acceptable Alternatives to Insurance Industry Certificates of Insurance:
A copy of the full insurance policy which contains a thirty (30) days' cancellation notice provision (ten
(10) days for non-payment of premium) and additional insured and/or loss -payee status, when
appropriate, for the City.
Binders and Cover Notes are also acceptable as interim evidence for up to 90 days from date of
approval