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Home My WebLink About5157 Contract Number: 5157 Vendor STAN PALMER CONSTRUCTION, INC. Subject Highway Safety Improvements Projects Department: Engineering File Class: LEG 12 -1 Begin Date: 8/6/2012 End Date Review Date Vault Date Comments CO #1 3/11/13, CO #2 5/1/13 • CITY OF BREMERTON y CHANGE ORDER CONTRACT CHANGE ORDER NO 1 PROJECT NAME Highway Safety Improvements Project PROJECT NO 10262 CONTRACTOR Stan Palmer Construction ORIGINAL CONTRACT AMOUNT $747,640 73 DAYS 80 PREVIOUSLY APPROVED CHANGES $0 00 DAYS THIS CHANGE $9,623 39 DAYS REVISED CONTRACT AMOUNT $757,264.12 DAYS This Change Order covers changes to the subject contract as described herein The Contractor shall construct, furnish equipment and materials, and perform all work as necessary or required to complete the Change Omer Items The increase or decrease in contract price shown below includes any applicable taxes DESCRIPTION OF CHANGES INCREASE IN (DECREASE) IN CONTRACT CONTRACT CONTRACT TIME ~ AMOUNT AMOUNT EXTENSION (DAYS) o: a: X 1 Jack hammer existing traffic pole bases at 5 and Warren Avenue 67270 Taxes 5785 X 2 Jack hammer existing traffic pole bases at 4 t° Street and Warren Avenue 19950 Taxes 1716 X 3 Jack hammer existing traffic pole base at NE corner of Burwell Street and Naval Avenue 57183 Taxes 4918 X 4 Emergency work to restore traffic signals at 6` Street and Naval Avenue 721 80 X 5 Subcontractor providing traffic control while emergency work to restore traffic signals at 6th Street and Naval Avenue is being done. 38901 X 6 Sawcut and remove asphalt around traffic loops at the SW and SE corners of 6 Street and Naval Avenue 42228 X 7 Jack hammer existing traffic pole bases at 6' Street and Naval Avenue 29307 X 8 Lower electrical boxes at SW corner of 16 Street and Warren Ave 34749 Taxes 2988 X 9 Extend opticom wires at 16 Street and Warren Avenue — Electrical Subcontractor 1,66243 CONTRACT CHANGE ORDER NO PROJECT NAME Highway Safety Improvements Taxes 14297 X 10 Extend opticom wires at 16`" Street and Warren Avenue — Traffic Control Subcontractor 56058 Taxes 4821 11 Credit on all electrical work (1,403 50) X 12 Survey staking for Warren Avenue 4,45760 Taxes 38335 NET CHANGE IN CONTRACT AMOUNT 11,026.89 (1,403.50) INCREASE OR (DECREASE) Contractor acknowledges and accepts that this Change Order constitutes final settlement of all claims of any kind or nature ansing from or connected with any work either covered or affected by this Change Order, including, without limitation, claims related to contract time, on -site or home office overhead, or lost profits Nothing in this Change Order shall limit the City's right to bring a claim for past performance The undersigned Contractor approves the foregoing Change Order as to the changes, if any, in the contract price specified for each item, including any and all supervision costs and other miscellaneous costs relating to the change in work, and as to the extension of time allowed, if any, for completion of the entire work due to said Change Order This document will become a supplement of the contract and all provisions will apply hereto It is understood that this Change Order shall be effective when approved by the City of Bremerton The parties whose names appear below warrant that they are authorized to enter into a change order that is binding on the parties of this contract In addition, Contractor warrants that it has or will inform the surety of this change, and shall take appropriate action to modify any bonds required under the contract to address this change RECOMMENDED � -i 2f 2 7 I/3 PROJECT ENGINEER Date RECOMMENDED 8 3 CI ENGINEER/PUBLIC ORKS DIRECTOR Date ACCEPTED CONTRACTOR Date APPROVED MAYOR D to APPROVED AS TO FORM: ATTEST: c B erton City Attorney City Clerk ---� Page 2 of 2 CITY OF BREMERTON CHANGE ORDER CONTRACT CHANGE ORDER NO 2 PROJECT NAME. Highway Safety Improvements Project PROJECT NO 10262 CONTRACTOR* Stan Palmer Construction ORIGINAL CONTRACT AMOUNT: $747,640 73 DAYS 80 PREVIOUSLY APPROVED CHANGES. $9,623 39 DAYS - THIS CHANGE $3,628 25 DAYS REVISED CONTRACT AMOUNT. $760,892 37 DAYS This Change Order covers changes to the subject contract as described herein The Contractor shall construct, furnish equipment and materials, and perform all work as necessary or required to complete the Change Order Items. The increase or decrease in contract price shown below includes any applicable taxes DESCRIPTION OF CHANGES INCREASE IN (DECREASE) IN CONTRACT CONTRACT CONTRACT TIME AMOUNT AMOUNT EXTENSION ($) ($) (DAYS) oe o: X ] Punchlist items completed not covered in the Contract 75258 X 2 Asphalt patch at SE corner of Burwell Street and Naval 1,20022 Avenue Taxes 10322 X 3 Traffic Control for asphalt patching at SE corner of Burwell Street and Naval Avenue 560.58 Taxes 48.21 4 Overall change in contract amount based on the difference between the total increase on some bid items and the total decrease on some bid items. 96344 NET CHANGE IN CONTRACT AMOUNT 3,628.25 INCREASE OR (DECREASE) Contractor acknowledges and accepts that this Change Order constitutes final settlement of all claims of any kind or nature arising from or connected with any work either covered or affected by this Change Order, Including, without limitation, claims related to contract time, on -site or home office overhead, or lost profits Nothing in this Change Order shall limit the City's right to bring a claim for past performance. The undersigned Contractor approves the foregoing Change Order as to the changes, if any, In the contract price specified for each Item, including any and all supervision costs and other miscellaneous costs relating to the change In work, and as to the extension of time allowed, if any, for completion of the entire work due to said Change Order This document will become a supplement of the contract and all provisions will apply hereto It is understood that this Change Order shall be effective when approved by the City of Bremerton CONTRACT CHANGE ORDER NO 2 PROJECT NAME: Highway Safety Improvements The parties whose names appear below warrant that they are authorized to enter into a change order that is binding on the parties of this contract In addition, Contractor warrants that it has or will inform the surety of this change, and shall take appropriate action to modify any bonds required under the contract to address this change RECOMMENDED I `� 29I J3 PROJECT ENGINEER Date RECOMMENDED -//Z- S � 3 NGINEER/PUBLI�WOR�KSDIRECTOR Date ACCEPTED. e WRXQ>r Date APPROVED C- Ol r.3 MAYOR Dafe APPROVED AS TO FORM: ATTEST: Bremerton Ctty Attorney City erk Page 2 of 2 Contract Number. 5157 Vendor• STAN PALMER CONSTRUCTION, INC. Sub�ect Highway Safety Improvements Pro�ects Department: Engineering File Class: LEG 12-1 Beqin Date. 8/6/2012 End Date: Review Date• Vault Date Comments• CONTRACT CITY OF BREMERTON, KITSAP COUNTY, WASHINGTON THIS AGREEMENT, made and entered into th�s 6th day of August , 2012, between the C�ty of Bremerton under and by virtue of T�tle 35 RCW (c�t�es) as amended, and Stan Palmer Construction Inc. here�nafter called the Contractor WITNESSETH That in consideration of the terms and cond�tions conta►ned herem and attached and made a part of this agreement, the part�es hereto covenant and agree as follows I The Contractor shall do all work and furnish all tools, mater�als and equipment for the Htghway Safety Improvements Pro�ect, in accordance with and as described �n the attached Plans and Specifications, and the 2012 Standard Spec�ficat�ons of the Washington State Department ofTransportation which are by this reference incorporated herem and made part hereof and shall perform any changes �n the work in accord w�th the Contract Documents The Contractor shal) provide and bear the expense of al( equipment, work, and labor, of any sort whatsoever that may be required for the transfer of materials and for constructing and complet�ng the work provided for in these Contract Documents except those �tems ment�oned there�n to be furn�shed by the City of Bremerton II The C�ty of Bremerton hereby contracts with Conh actor and Contractor hereby agrees to prov�de the matenals and to do and cause to be done the above described �vork and to complete and finish the same �n accord with the attached Plans and Specifications and the terms and conditions herein contamed and hereby Contracts to pay for the same accord�ng to the attached spec�fications and the schedule of unit or demized pr�ces at the t�me and m the manner and upon the conditions provided for in th�s Contract f[1 The Contractor �s and shal) be at all times acting as an independent contractor and not as an employee of the C�ty The Contractor shall secure at �ts expense, and shall be responsible for all payments of mcome tax, social security, state mdustr�al insurance compensation, unemployment compensation, and all other payroll deduct�ons for the Contractor, officer, agents, employees and sub-contractors The Contractor shall also secure all applicable bus�ness licenses, �f requ�red, �n connect�on with the contract services, includ�ng all required I�censes for Contractor's officers, agents, employees and subcontractors IV The Contractor for himsetf/herself, and for h�s/her he�rs, executors, adm�nistrators, successors, asstgns, does hereby agree to the fuil performance of all the covenants herein conta�ned upon the part of the Contractor V It is further prov�ded that no l�ability shall attach to the City of Bremerton by reason of entering into this Contract, except as prov�ded herein VI INDEMNIFICATfON Contractor shall defend, mdemnify and hold the City, rts officers, offic�als, employees, agents and volunteers harmless from any and a(I cla�ms, in�urtes, Crty of Bremerton Hrghway Safety lmprovements Pro�ect LD-9 January 1012 damages, losses or surts includ�ng al) legal cost and attorney fees, arising out of or in connection with the performance of this agreement, except for m�u� ies and damageti solely caused by the Crty's negltgence "f he City's �nspection o� acceptance of any of Contractor'S �vork when completed shall not be grounds to avoid any of these covenants of indemnification Should a court of competent�urisdiction determine that this agreement �s sub�ect to RCW 4 2a 1 15, then, in the event of liability for damages ar�sing out of bodily mJury to persons or damages to property cai�sed by or resultmg from the concurrent negligence of the Contractor and the City, its officials, employees, agents and volunteeis, the Contractor's I�ability hereunder shal) be only to the e�.tent of the Contrac,tc�r 5 negligence IT IS FURTHER SPCCIFICALLY AND EXPRESSLY UNDERSTOOD THAT TH[S INDEMN[FICATION CONSITUTES THE CONTRACTOR S WA(VER OF IMMUNITY UNDER tNDUSTRIAL INSURANCE, T IT[.E 51 RCW, SOLELY FOR THE PURPOSE OF THIS [NDEMN[FICATION THE PAR T[ES ACKNOWLEDGE THAT THEY HAVE MUTUALLY NEGOTIATED TH[S WAIVER The provis�ons of this section shall survive the expiration of termuiation of this agreenient IN WITNESS WHEREUF, the Contractor has executed this instrument, on the day and year first below wntten and the Local Agency Approving Author�ry has caused this instrument to be executed by and m the name of said C�ry of Bremerton the day and year first above written C�cecuted by the Contractor this 6th day of August ,?p 12 T om Abplanalp, Sr Vice Preside Contractor EYecuted by the Local Agency this 3� ST day of �uL. �_, 20� (SE,AL) C�rty nf [3rc�ne�lon HtghxavSu feryhnproverne�rrsP�o�ect LD-l0 Jantru�� 101? � � �� Crty o Bremerton Approving Authorrty Proposal To: The City of Bremerton City Clerk 34S 6 Stre�t, Su�te 6U0 8remertory Washmgton 98337 Th�s certifies thak the unders�gned has exammed the location of H�ghway Safety Impravements Project City af Bremerton No 102b2 ln the (;ity of Bremerton And that the Plans, Specificat�ons, and Contract governmg the work embraced m th�s improvement, and the method by wluct► payment will be made for said work, is understood The undersigned hereby proposes to undertake and complete the work embraced in th�s improvement, or as much thereof as can be completed vrnth the money available in accordance with the sa�d Plans, Specificat�ons, and Contract, and the following sehedule of �tes and prices (Nate. Umt pr�ces for all items, all extensions and total amouni of bid must be shown All entries mvst be typed or entered in u�k.) City of Bremerton Highway Safety Imprwements Pro�ect LD-2 Junuary 2011 Page 2 Prowded to Builders Exchange of WA, Inc For usage Condit�ons Agreement see www bxwa com - Always Venfy Scale BREMERTQN HIGHWAY SAFETY IMPROHEMENTS PROJECT BID FORM NQ � UNtT � WORK ITEM � QUANTITY � UMT COST I TdTAL COST SCHEDULE A - K�tsap Way {SR310) TOTAL{SCHED�LEA) 541,2�5 is Page 3 Provided to Builders Exchange of WA, Inc For usage Cond�ons Agreement see wavw bxwa com - Always Venfy Scale SUBTOTAL(RULE170} S3a,00� so '�/�(($8 $3,268 65 BREMERTON HIGHWAY SAFETY IMPROVEMENTS PROJECT BID FORM ITEM NO UNIT WpRK ITEM QUANTITY UNIT COST TOTAL COST SCHEDU LE B- Wamen Avenue (SR303j Burweil to bth Streat TOTAL (SCHEDULE B) � a 35 . IOg (o A Qg Page 4 Provided to Builders Exchange of WA, Inc For usage CondiUons Agreement see www b�rva com - Always Venfy Scale SUBTOTAL (RULE 770) � 3 �� TAX (8 6 %) BREMERTON HIGHWAY SAFETY IMPRC?VEMENTS PROJECt BID FORM ITEM MQ UNIT W�RK ITEM QUANTITY UNIT COST TOTAL COST SCHEDULE C- Naval Avonue and Burwell SUBTOTAL (RULE 170j � 7 9 (oa TAX (8 6 %) � / 7 -�}S TOTAL (SCHEDULE C) � � Sy.. uS BREMERTON HIGHWAY SAFETY IMPROVEMENTS PROJECT BID FORM ITEM NO. UNIT WORK ITEM QUAPITiTY UNIT COST TOTAL COST SCHEQULE D- Naval Avenue and Bth Street SUBTOTAL (RULE 171) � 9��g 3S o TOTAL (SCHEDULE D) � q�I, g 3 S o� BREMERTON HIGHWAY SAFETY IMPROVEMENTS PRQJECT BID FORM ITEM NO UNIT W�RK ITEM QUANTITY UNIT COST TOTAL CaST SCHEDULE E- Naval Avenue and 11th Street TOTAL (SCHEDULE E) �' I� 5- �3 �� SUBTOTAL (RULE �71) � �,� ,�'7 � uv � - BREMERTON HIGHWAY SAFETY IMPROVEMENTS PROJECT BID FORM ITEM NO, UNIT WORK ITEM QUANTiTY UNIT COST TCJTAL COST SCHEDt1LE F- Warren Avenue (SR303) and 16th Street TOTAL (SCHEDULE F) 1 �l'� 5 95 3(0 SUBTOTAL (RULE 170) 13 31'fy 90 TAX (8 6%) 1 � � 4�� 4(� BREMERTON HIGHWAY $AFETY IMPROVEMENTS PROJECT BID FQRM ITEM NO.� UNIT � WORK ITEM � QUANTITY � UNIT COST � TOTAL CO5T ALTERNATE BID - Montgomery Avenue and 11th Street (The City rssarves t!►a right to delete the altemate bid) TOTAL (ALTERNATE BIDj a �, � �Q �� GRAND TOTAL 7(p q� (06 0. 73 SUBTQTAL {RUlE 171) a �, �'�D 0� O PRUPOSAL - CONTYNUED The b�dder is hereby advised that by signing of ttus proposal helshe is deemed to have acknowledged all requ�rements and signed alI cert'rficates heretn A proposal guaranty ut an amount of five percent {5%) of the t�tal bid, based upon the appraximated estunate of quanhties at the above prices and m the form as indicated below, is attached hereto. Cash Cashier's Check In the amount of Dollars ($ ) payable ta the City of Bremerton Certified Check In the amount of Dollars ($ ) payable to the City of Bremerton Proppsal Bond Certificate # 004495607 Receipt is hereby acknowtedged of (The Bidder hereby acl,cnowledges ceceipt of addenda by inmaling after each addendum received.) Addendum No 1 Addendum No 2 Addendum No 3 Signature o�'Auth ' Officiat(s): Tom Abplanalp, Sr Vice-President F�rm Name {Address) State of Waslungton Contractor's License No C�ty of Bremerton Busmess L�cense No Federa] ID No. Note Stan Palmer Construction, Inc 1508 Ni Loop Bremerton, WA 98312 ST-AN-PC-*202NF 12861 91-1078790 This proposa[ �s not transferable and aay aiterahon af the firm's name entered hereon wrthout prior permission from the Crty of Bremert�n will be cause for cons�den�ng the proposal nonresponsive and subsequent re�echon ofthe bid Please refer to Sectson 1-02.6 of the Standard Speclficat�ans, re "Preparataon of Proposal " Should �t be necessary ta modify this proposal either m wnting or by electromc means, please make reference to the followmg proposal name in your commumcahon- Hi�hwaY Safety Improvements Pro�ect Crty of Bremerton Hrglaway Safety Improvements Pro�ec[ LD-4 January 2012 Page 10 Provided to Builders Exchange of WA, Inc For usage Conditions Agreement see www bxwa com - Always Venfy Scale Failure to return this Declaration as part of the bid proposal package will make the bid nonresponsive and ineligible for award. NON-COLLUSION DECLARATION i, by signing the proposai, hereby deciare, under penalty of per�ury under the taws of the Un�ted States that the follow�ng staternents are true and correct 1 ThBt the undersigned person(s), firm, associaUon or corporation has {have) not, either direc.tly or md�rectly, entered mto any agreement, partic�pated �n any colfusian, or otherwise taken any action in restrarnt of free competitive biddrng in connection +nnth the pro�ect for which this proposal is subm�tted 2 That by sigrnng the srgnature page of this proposai, [ am deemed to have signed and to have agreed to the provisions of this declarat�on NOTICE TO ALL BIDDERS To report rigging activities call. 1-800-424-9071 The U.S Department of Transportation (USDOT} operates fhe above toli-free "hatline" Monday through Friday, 8 OOa m to 5•OOp.m , eastern time. Anyone wfth knowledge of possibfe bid rigging, b�dder collusion, or other fraudulent activ�ties should use the "hotline" to report such act�vities The "hotl�ne" is part of USDOTs contrnuing effort to identrfy and rnvestigate highway construction contract fraud and abuse and is operated under the direcfian of the USDOT Inspector General. Ail �nformat�an wdl 6e treated confident�ally and caller anonymity will be respected Ctry of Bremerron Highway Safely lmprovements Profect LA7 .IQnuQry 2p12 Page 13 Provided to Builders E�cchange of WA, Inc For usage Condrt�ons Agreement see www bxwa com - Always Venfy Scale Instructions far Disadvantaged Business Enterprise Utilization Certification (DOT Form 272-056) To be eligible for award of the contract, the bidder shall properly complete and submit a Disadvantaged Business Enterprise Utdization Certif�cat�on form with the bidder's sealed Bid Proposal that demonsfrates how the bidder intends to meet the OBE Condition of Award (COA) goal Box 1 Name af B�dder (Proposal holder) submitting a bid Cofumn 1 Name of the D�sad�antaged 6usiness Enterprise (DBE) and Ce►tificate Number Column 2 The Pro�ect Role that the DBE will be pertorming as follows; • Prime, • Jomt Venture, • Subcontractor, • Manufacturer, • Regular Dealer* The role is used to determine what portEOn of the DBE participation may be cred�ted toward the goal See Crediting DBE Particrpaflon toward Meeting fhe Gaal as descnbed in the �isadvantaged Business Enterpnse Condif�on of Award Partrcrpation specrF�cat�on. Column 3 A descnption of the work to be performed by the DBE consistent w�th the eligible Descriprion of Worlc in the D�rectory of Cert�ed DBE firms If the DBE ts to perform a portion of a btd item, then state Partial and what work is included, e g., "Electricai (Partiai) — Trenchmgp "Mob�lization" will not be accepted as a descript�on of work as it is not considered a distinct item of wo�k that a DBE is certified to perform The bidder may �ly upon the descnptors listed �n the Directory a# Certified DBE Firms Column 4 The dollar amount for each DBE listed m the certification that the prime intends to apply towards meeting the DBE contract goal tt may be that only a portion of the amount paid to the DBE is eiig�ble as COA participation See Cnedrfing OBE Particrpahon in the special provisions, D�sadvantaged Busrness Enterpnse Condrtron of Award Participafron , Box 2 The goal stated in the contract m terms of a dollar amount or a percentage as noted under the general special provision, DBF Condlt�on ofAwaraf (e0A) Gaal, Orsadvantaged Bus�ness Enterprise Condrflon of Award Participafion When expressed as a percentage rt is a percentage of the sum total of all b�d items as submitted in the bidder's proposal Box 3 The total for calumn 4 This value must equal or axceed the goal amount "` Note In accordance with 49 CFR 26 55{e){2){i), if the materials or suppl�es are purchased from a DBE Regular Dealer, the amount to be counted towards the DBE wili be sjxty percent (60%) af the cost of the materials or suppl�es, e g, Materia! cost $'EOO,OOQ, allowable amount toward DBE goal, $60,000 DOT Form 272-056A EF InatrucUons Revised 07l2011 Page 14 Provided to Bwlders Exchange of WA, Inc For usage Conditions Agreement see www bxwa com - Always Venfy Scale Locai Agency Disadvantaged Business Enterprise Utiliz�tion Certification To be eligible for award of this contract the btdder must fill out and submd, as part of �ts bid proposal, the fopowmg Disadvantaged Business Enterpnse iJt�l�zation Certflcat,on relating to Disadvantaged Business Enterprise (D9� requfrements The Contractmg Agency shalt consider as non-responsive and shall re�ed any bid propasai that does not contam a DSE Cert�ficaUon which properly demonstrates that the bidder vudl meet fhe DBE panc�ipatiun requUements in one of the manners provided fo� m the proposed oontract The Buider rPlust submit good faith effort documentabon s►njy in the eventthe bidde�'s effflrts to sohat sufficient DBE parUcipatian has been unsuccessful 3he successfuf bidcler's Disad�antage Busmess Enterprise lJtTl¢ation Cert�fication shall be deemed a part ai the resulting contract Informahon an certified firms is avadable from OMWBE, telephane 360-664-9750 ar Toll Free 1-866-208-1064 STAN PALMER CONSTRUCTION, INC . �rt�ies thatthe Disadvantaged gusrness Enterpr�ae (DBE) (Sox 11 Name of B�dder Firms listed betow have been oontaded regardmg pa�hcipation on this proJect. If this b�dder is successfut on this pro�ect and is awarded fhe cor�tract, d shall assure that subcontracts or supply agreements are executed w�th those firms where an'Art►ounf fo be Apphed Towards Cioal" �s hsted_ (If necessary, use addiUonal sheet ) Column 1 Column 2 * Cotumn 3 �olumn 4 ** ProJect Rote Amount to Name of OBE (Pdme, JolntVenture Description of Work be Applied Certiflcate Plumber 5ubcorttractor, Manufackurer, �e9uia� Towards Goal Dea[er) q Advanced Government Services� Inc Flagging (2 E , Traffic �� Certificate# D2F8719009 Subcontractor Control) Services $85,000 00 2 3 4 5 6 7 8 9 zo 0 o s *,� Disadvantaged Business Enterpnse Subcontracting Goal /Q � DR� Total $ �C'�,ww ,/ eox 2 Box 3 "` Regutar Dealer status must be approved pnor to bid submdtal by the Office of Equal Opportunfty, Wash State Dept of Transportation, on each contrect *"' See the sedwn "Credifing DBE PartiGpadon Toward Mseting the Goal" fn the Gontract DocumeM """ The Cantracting Agency wi{i u�fue th�s amount to detertnme whether or not the buider has met the goal in tf►e event of an anthmetic d�fference be[ween this total and the sum of the mdmidual amounfs listed above, then the sum of the amo�mts tisted shall prevall and the total wdl be rewsed accordmgly Panc�apation In excess of the goal amount will be oonsidered voiuntary or race-neutra[ pardcipaUon SR DOT Form 272-058A EF 0712011 Page 15 Provided to Budders Exchange of WA, Inc For usage Condit�ons Agreement see www bxwa com - Always Venfy Scale L�cal A�ency �isa�dvantag�e� �u�ir�ess IEnte�pri�� {�� Ul�rif�ert ��n��a�ion Documen� As an authc�rized representati�e af the Disadvantaged Business Enterprise {DBE}, ! canf�rm that we have been contacted by the refer bidder with regacd ta the referenced pro�ect and if the b�dder is awarded the contract we wdt errter inta a� ag�ement wi#h th� bidder to participate in the pra�ect consisterrt with the �nforma�on �rov�ded in the bidder`s Disadv,�n�ged 8usiness Entemnse Utilization Cerhfication. Conb�act Titls• B REMERTON H2GHWAY SAFETY 2MPROVEMENTS Bldder's Business Name• STAN PAI,MER CONSTRUCTZON, SATC DBE`s Busines9 Plame: ��.C(1„Y�C� � Ov � r1 M 2.,►�►�' S-�.�'� � C�. S`''�C. DBE Slgnature: ��U�,vV.-�. ��,f--- � DBE's 'i'itte: �+�.t_ S � Ga.a. r�. '� Date: �'��i' � 'Z The erttnes mus# be cons�sferrt w�th what ►s sh�wn on the bidder's Q�sadvar�targed Busfness Enterpnse U�liaaation Cerhfication. Fadure to do so wili resutt in bid rejectran. See con#ract pravision; Disavantaged Busmess Entatpr�se Corrditron of Award Parfrcrpatian aesCrtptton of Work � 1f'4 �� c C On� ra � s L��J � C. 2 S Arnaunt #o � Appl�ed Towards Goal: '� � s� Ol� (� 0 0 SR ppT 7 �122-031A EF