ATTACHMENT 5 BID/BIDDER CERTIFICATION SHEET

Invitation For Bid IFB Number 08A2866

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 ce1tification sheet. C. I have read and understand the DVBE participation requirements and have included documentation

demonstrating that I have met the pa1ticipation goals. D. The signature affixed hereon and dated ce1tifi es 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 firm offer for a 90-day period.

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

I . Company Name

DALKE & SONS CONSTRUCTION, INC.

2b. Email Address barry@dalkeandsons.com

3. Address

4585 Allstate Drive, Riverside, CA 92501

2. Telephone N umber

(951)27 4-9880

2a. Fax Number

(951 ) 274-9880

Ind icate your organization type: 4. D Sole Proprietorship I 5. D Partnership I 6. I!] Corporation

Indicate the applicable employee and/or corporation number: f'.;te.. NuWl.bvt'" : 7. Federal Employee ID No. (FEIN) -3 3- o t/ {p b 1.-/ S-S- I 8. California Corporation No. ~l l, 7 go<o I

Indicate the Department of Industrial Relations information: 9. Contractor Registration Number 1000003081

Indicate applicable license and/or certi fication information: I 0. Contractor' s State Licensing

Board Number

12. Bidder' Name (Print)

DALKE & SONS CONSTRUCTION, INC

11. PUC License Number CAL-T-

13. Title

Barry Dalke, Vice President

15. Date 12/22/2017

16. Are you certified with the Department of General Services, Office of Small Business and Disabled Veteran Business Enterprise Services (OSDS) as:

a. Small Business Enterprise If yes, enter certification nlllnber:

Yes D No [gj b. Disabled Veternn Business Enterprise Yes D No 00 If yes, enter your service code below:

NOTE: A copy of your Certification is required to be included ifeither of the above items is checked "Yes".

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

17. Are you a Non-Small Business committing to the use of 25% Certified Small Business Subcontractor Participation? Yes D No 1K]

If Yes, complete and return the Bidder Declaration form, GSPD-05-105 with your bid.

STATE OF CALlFORNlA · DEPARTMENT OF TRANSPORTATlON

BID PROPOSAL ATTACHMENT 1 ADM-1412 (REV. 11/20 15)

CONTRACTOR'S NAME (Please Print): CONTRACT NO. DALKE & SONS CONSTRUCTION.I INC. ITEM ESTIMATED UNIT OF

ITEM NO. QUANTITY MEASURE

Repair and seal concrete floor and walls, remove and dispose of lead paint and paint exposed

1 I Each interior steel and interior metal roof at the Cajon Salt Barn in San Bernardino County as noted in Exhibit A, Scope of Work (SOW)

Repair and seal concrete floor and walls remove and dispose of paint and paint exposed interior

2 I Each steel and interior metal roof at the NB 15 FWY/HWY 395 Junction in San Bernardino County as noted in Exhibit A, SOW

( 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.

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

Agreement Number 08A2866 Page 1 of I

UNIT PRICE TOTAL ( Price Per Unit of (Estimated Quantity X Unit Measure) Price)

$ -~/iS/f4l "'2- $ 355,1'-/I 0_;..

$ 2..,1-fz_ , Z. 7 \ - $ Zyz.,Z.1<:c ~

TOTAL THIS .::,,~

$596, 2-2-D -PROPOSAL

State of california-Department of Genera.I Services, Procurement Division GSPD-05-105 (REV 08/09)

ATTACHMENT 2

BIDDER DECLARATION

1. Prime bidder information {Review attached Bidder Declaration Instructions prior to completion of this form):

Agreement Number 08A2866 · Page 1 of 2

a. Identify current California certification(s) (MB, SB, NVSA, DVBE): ______ or None J;81 (lfMNone~go to Item #2)

b. Will subcontractors be used for this contract? Yes ~ No O (If yes, indicate the distinct element of work your firm will perform in this contract e.g., list the proposed products produced by your firm, state if your firm_ owns the transportation vehicles that wil l deliver the products to the State, identify which solicited services your firm will perform, etc.). Use additional sheets,as necessary.

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c. If you are a California certified DVBE: (1) Are you a broker or agent? Yes O No 121_ {2) If the contract includes equipment rental, does Ff cooany own pt least 51 % of the equipment provided in this contract (quantity a nd value)? Yes No N/A~

2. If no subcontractors will be used, skip to certification below. Otherwise, list all subcontractors for this contract. (Attach additional pages if necessary):

Subcontractor Name, Contact Person, Subcontractor Address CA Certification (MB,SB, Work performed or goods provided Corresponding Good 51% Phone Number & Fax Number & Email Address NVSA, DVBE or None) for this contract % of bid price Standing? Rental?

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CERTIFICATION: By signing the bid response, I certify under penalty of perjury that the informat ion provided is true and correct.

State of Californi&-Oepan:ment of General Services, Procurement Division GSPD-05- 105 (REV 08/09)

7

ATTACHMENT 2

BIDDER DECLARATION

c. If you are a California certified DVBE: (1) Are you a broker or agent? Yes D No Da:-

Agreement Number 08A2866 · Page 1 of 2

(2) If the contract includes equipment rental, does [f co0any o~ least 51 % of the equipment provided in this contract (quantity and value)? Yes No N/A-ni

2. If no subcontractors will be used, skip to certification below. Otherwise, list all subcontractors for this contract. (Attach additional pages if necessary):

Suhcontractor Name, Contact Person, Subcontractor Address CA Certification (MB,SB, Work perfonned or goods provided Corresponding Good 51% Phone Number & Fax Number & Email Address NVSA, DVBE or None) for this contract % of bid price Standing? Rental?

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CERTIFICATION: By signing the bid response, I certify under penalty of perjury that the information provided is true and correct.

SI'!, TE Of· CALIFORN11; - DEPAR TMENT OF GENEl'l,1.L. $EfMCES i'ilOCUREMENT cliVI SIOM

DISABLED VETERAN BUSINESS ENTERPRISE DECLARATIONS STD 8-:J (Rev. 512005)

Instructions : The disabled veteran (DV) owner(s) and DV manager(s) of the Disabled Veteran Business Enterprise (DVBE) must complete this declaration when a DVBE contractor or subcontractor will provide materials, supplies, services or equipment (Military and Veterans Code Section 999.2]. Violations are misdemeanors and punishable by imprisonment or fine and violators are liable for civil penalties. All signatures ~r~ made under eenalty 2!..i::2:..:e~rj~u~ryr..:.·- - - ----- --

SECTI0N 1

Name of certified DVBE Elevating Sales Corp.

Description (materials/supplies/services/equipment proposed):

DVBE Ref. Number: _1_7_85_2_5_9 __

Construction Related Materials & Logistics

Solicitation/Contract Number: __ G_0_14_0.;;.C ____ ___ _ SCPRS Rei. Number ___________ _

-- ·-- -----SECTION 2

(FOR STATE USE ONLY)

--- - ·---·- ·- --· - .. -·- -----~ ----·-~~---~--~-----APPLIES TO ALL DVBEs. Cl1eck only Q.Q_g box in Section 2 and provide original signatures.

,M I (we) declare that the DVBE is not a broker or agent, as defined in Military and Veterans Code Section 999 .2 (b), of materials. supp lies. services or equ;pment listed above. Also. complete Section 3 below if renting equipment.

0 Pursuant to Mili tary and Veterans Code Section 999.2 {f). I (we) declare that the DVBE is a broker or agent for the princ1pal(s) listed below or on an attached sheet(sL (Pursua11I lo Mililary and Velera11s Cocle 999.2 (e), Slate fu11cls expenc/ec/ for equipme11 / ren/ecl from equ1jJme11I /J rolwrs pwsuan/ lo co11/rac/s aware/eel w]J.lef)I/Jis section sfla/1 no/ /Je crech/ecl /aware/ //Je 3-porce11/ DI/BE pa1t1cipalion uoal.) ·

All DV owners and managers of the DVBE (attach additional pages withs 1rici

Lawrence M. Spazafumo Jr. 12-22-1 7 (Prinied Name of DV Owner/Manager) (Dille Signed)

(Pr :nled Name of DV Owner/Manager) (Signature of DV Owncr/M,1nagcr) (Dute Signed)

Fi rm/Principal for whom the DVBE is act ing as a broker or agent: (If more than one iirm. list on exIra sheets.)

Firm/Principal Phone : Address:

(Print or Type Name)

----·--·---,. • - ---· • %.-~~· --·. ~· -·~-~····· s EcT1O N ··r · -. APPLIES TO A L L 6 vsTs'"rHAT RENT EQUIPMENr AND.DECLA.RE T HE DVBE IS NOT A BROKER.

lSlPursuant to Military and Veterans Code Section 999.2 (c), (d) and (g), I am (we are) the DV(s) with at least 51 % ~ wnership of the DVBE . or a DV rnanager(s) oi the DVBE. The DVBE maintains ceriificat ion requ irements in

accordance with Mil itary and Veterans Code Section 999 et. seq.

0 The undersigned owner(s) own(s) at least 51 % of the quantity and value of each piece of eq uipment that will be rented for use in the cont ract identified above. I (we). the DV owners of the equipment, have submitted to the administering agency my (our) personal federal tax return(s) at time of cert ification and annually thereafter as defined in Milita,y and Veterans Cocle 999.2, subsections (c) ancl (g). Failure /Jy tile disa/Jleel veteran eelufff{nen/ owner(s) to submit //1eir personal fee/era/ lax relurn(s) lo /he aelrninislenng agency as elefineel in Milila1 1 <irrr! Ve'erans Coele 999.2, su/Jsec/ions

. (c) and (g), will result in 1/Je OVBE being deemecl an equipment /) raker. 1/ Disabled Veteran Owner(s) of the DV BE (attach additional paues with sign, lrc o s for ,

Lawrence M. Spazafumo Jr. (Prinled Name)

331 Brea Hills Ave., Brea, CA 92823 45-5519767 (Address of Owner) (TeIept1one) (Tax Identification Number of Owner)

Disabled Vetera n Manager(s) o f the DVBE (attach addi tional pages with sufficient sign11turc blocks for each person to sign):

(Pnnted Narne of DV Manager) (Sigm1I1Jre of DV Manager) (Dale Signed)

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