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State of California--Natural Resources Agency ❑ HQ. E]OHV ❑ NO. ❑ SO. No. A 1855029 DEPARTMENT OF PARKS AND RECREATION CONTRACTTYPL DATE PREPARED AGREEMENT FOR SERVICES ❑A&E ❑ Consuitant F] Service(One-time only) 10/16/2018 This document is not valid if the Total Amount DISTRICT/DIVISION i PARK WORK LOCATION exceeds$9,999.99 including all applicable faxes. Twin Cities/OHV I Carnegie NbI CAL PURCHASE ORDER NO. BUlGUPC BUS DPR CONTACT PERSON(Pfintortype) CONTACT PHONE NO. b ODOR 4 O uNlr� 1 David Burns { 925 ) 409-8400 CONTRACTOR'S NAME(Print or type) PHONE NO. LICENSE NO.(P(ofessional Services) American Valley Waste Oil, Inc ( 800 ) 732-4645 MAILING ADDRESS REMITTANCE ADDRESS P.O.Box 340 Dehli, Ca SMALL BUSINESS TYPE LJ SB LJ MB or No IDVBE ❑ Yes or Ll No SUPPLIER NO. or Q STD.204 Certification No., Exp.Date: Kelt.No.: Exp.Date: _ _V000012179-00 attached Based on the Estimated amount of: $ 9250.00 the contractor agrees to furnish all labor,equipment,and materials necessary to accomplish the following: Vendor to remove 10, 1 cubic yard bags and dispose of all contaminated soil in provided Bags CAL EPA# CAL000361443 Anticipated date of completion: // so / INSURANCE REQUIREMENTS: ❑� Workers'Compensation [✓Automobile Liability General Liability ❑ NIA EXHIBITS, Items checked below are hereby incorporated by reference and made a part of this Agreement by reference as if attached hereto: OGTC 412017 0 CCC412017 . The GTC and CCC can be viewed at www.ols.dgs.ca.gov1Standard+Language. INTEI_LEC1'.UgqL PROPERTY: Any works deZoped.durin arld/or urs�ant to this a reemgl�t b Contract r, includin all related Co r' hts and other pro�n@tary nghhts ttlerein, as marYi now Pt';t;and/or whiche ea come into existencg,shall I�el�ng to the tate upon�reation,and s�a+lgcontinue in the State's exp usive pw ershlp upon terms atlon o t11Is agreement. T Total Amount of this agreement including all applicable taxes is: $ CONT(r'SQ=E PRINTED NAME TITLE CONTRACTOR JOB REF.N0. DATE � 6D Lv� (Optional) _ ill 1,f2 Z6 i EXPENDITURE CODING (Departmental Use Only) Appr.Ref Fund ENY I Account Aft Account 1 Prog Project Activity I Reporting Structure CAL-Card Amount �o 11392 �vl� s3a4(000l �3a` ocn�l a�� 3ngo 1na7 v6as 9"50,0 AWARD METHOD USED(Check one) ❑Informal Quotes/Bids(List contractor names and prices for of feast 2 quotes/bids below): 0 Fair& Reasonable Determination(Sign the following certification statement): I certify that the cost of the acquisition is fair and reasonable and that the listed cost is low. I further certify that IaF of California procurement experience and knowledge to make this cast analysis determination. The acquisition cost is so low that the cost to the State to verify the pr€ting life more than any potential beneftthat could be reasonably gained from searching cut the marketplace for lower priced comparable acquisl6on. Certirler Signature ' Printed Name David Burns ❑Exempt from Bidding(Cite Exe tion DPR APP V LSIGNATURE PRINTEDS NAME TITLE C �r DATE10. �r CERTIFICATION OF COM ' ETION I hereby certify that the above sanufAs were ret ived bV and necessary for use of the State of California and that the quantity and quality are as indicated. SIGNATURE(Mu diffe t from p av gnat PRINTED NAME TITLE DATE WO K C014 ;TED \, k&LA r -,- STAN I TION: DivisionlDistrict keep original,attach scanned copy of the original to the FI$Cal Purchase Order(PO),copy to the Contractor DISTRIBU I WHEN PAI Y CAL-CARD: Same as Standard Distribution-plus: FI$Cal PO must be assigned to the PCard Cardholder DPR 285(Rev.212018)(Excel 511 012 0 1 8)