Bid Submittals: Responses must be submitted to: Hand Delivery, FedEx, UPS, other. Pomona, CA Pomona, CA 91766

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CITY OF POMONA REQUEST FOR BID SNACK AND BEVERAGE VENDING MACHINE SERVICES BID NO: 801.22.14-15 Type of Bid: Revenue Generating Service Bid Submittals: Responses must be submitted to: Mail Delivery Hand Delivery, FedEx, UPS, other City of Pomona City of Pomona Purchasing Division Purchasing Division P.O. Box 660 505 S. Garey Avenue Pomona, CA 91769 Pomona, CA 91766 SCHEDULE OF EVENTS: Post Bid 3/17/15 Questions Due Addendum Issued 3/24/15 Bid Due Date 3/23/15 by 3:00 P.M. 3/30/15 by 3:00 P.M. (The City reserves the right to change schedule of events without prior notice or responsibility to Bidders.) Website address: www.ci.pomona.ca.us Follow the path of Business; Current Bids and RFPs; Non-Construction Bids

Table of Contents 1. Introduction... 3 2. Bid Submission Instructions... 3 3. Inquiries... 3 4. Scope of Services... 4 5. Contract Term... 7 6. Contract Extension... 7 7. Contract Termination... 7 8. Required Forms and attachments... 8 9. Selection Criteria... 8 10. Reservation of Rights... 9 11. Terms and Conditions... 9 12. Insurance Requirements... 11 13. Definitions... 13 14. Company Summary Sheet... 15 15. Bid Sheet... 16 16. References... 17 17. Acknowledgement and Signature of Authorization... 18 18. City of Pomona Minority Business Questionnaire... 19 19. City of Pomona Statement of Non-Collusion By Contractor... 20 20. City of Pomona Agreement for Indemnification by Contractor/Vendor and Acceptance and Acknowledgment of Procurement Practices of The City of Pomona... 21 Page 2 of 21

1. INTRODUCTION The City of Pomona is seeking bids from experienced companies to provide snack and cold beverage vending machines. Vending machines will located at the Veterans Park Soccer Complex, Metrolink Station, Pomona City Hall Break-room, Library Break-room, and City Yard; and potential additional future locations as determined by the City. The City seeks to award a three (3) year contract, with an option to renew the contract on a year-to-year basis, for up to two additional years. 2. BID SUBMISSION INSTRUCTIONS Bids must be submitted in a sealed package, clearly marked with "Snack and Beverage Vending Machine Services, Bid No: 801.22.14-15. Bids received after the due date and time specified will not be accepted. Submittals must include: One (1) original; Two (2) copies; One (1) CD or flash drive. Bids submitted by telephone, e-mail, or faxed will be rejected. Rejected bids will not be returned and will be destroyed by the City 30 days after bid opening. In the event that only one response is received, the City reserves the right to cancel the Bid, return the unopened response to the Vendor, and re-advertise. Bids must be received in the Purchasing Division Office in accordance with the published Schedule of Events and delivered to the following location: U.S. Mail: City of Pomona Hand delivery, FedEx, UPS, other: City of Pomona Purchasing Division Purchasing Division P.O. Box 660 505 South Garey Ave. Pomona, CA 91769 Pomona, CA 91766 Bids will be publicly opened on the date and time identified herein; bid results for general services are typically posted on the City s website within one (1) to two (2) days after bids have been opened. Posted prices are preliminary in nature and may not reflect the final cost calculation, responsiveness or responsibility. For professional services, only the name of the bidder will be listed. No notification will be sent to unsuccessful bidders. The City s website address is http://www.ci.pomona.ca.us. To locate all posted documentation click on Business, Current Bids and RFPs, Non-Construction Bids. Please note: No other letters or correspondence will be sent. It shall be the Vendor s sole responsibility to check the City s website on a consistent basis for updates regarding bid results and award notices. 3. INQUIRIES Bidders must carefully examine the bid document and any addenda that may be posted on the City s website and seek clarification of any ambiguity, conflict, omission or error. Inquiries must be submitted in writing prior to the due date and time for questions as specified in the Page 3 of 21

Schedule of Events. If an answer materially affects the Bid, the information will be incorporated into an addendum and will be posted to the City s website for download. No other contact will be made by the City to vendors regarding any addenda to the bid. It shall be the Vendor s sole responsibility to check the City s website on a consistent basis to determine if any addenda or changes have been posted prior to the bid due date and time. All questions related to this bid or proposal must be directed to Keri Hinojos, Purchasing Manager at (909) 620-2039, via e-mail to keri_hinojos@ci.pomona.ca.us, or by fax to (909) 620-3711. Please note that per Section 2-975(2) of the Pomona City Code, any unauthorized contact by the bidder during the bid or proposal process with an official or city employee, other than those shown on the RFP or bid, the Finance Director, or Purchasing Manager, shall cause the bidder to be immediately disqualified from participating in the bidding process. 4. SCOPE OF SERVICES A. Locations of Vending Machines Bidders must visit each site prior to submitting a bid in order to assess size, space, and electrical requirements. Commissioned Vending Machines The CONTRACTOR agrees to pay the CITY a percentage of gross revenues for all commissioned vending machine products sold, and provide security cages at the following locations: 1) Veterans Park Soccer Complex, 1945 W. Mission Blvd, Pomona, CA 91768 Machines needed: (3) three beverage, and (1) one snack Security cages shall be provided by the vendor 2) Metrolink Train Station, 101 W. First Street, Pomona, CA 91766 Machines needed: (1) beverage, and (1) snack Security cages shall be provided by the vendor Non-Commission Vending Machines No commissions will be paid to the CITY for products sold at the following locations; therefore, product prices shall be lower than at Commissioned Machine locations: 1) Pomona City Hall, 505 S. Garey Ave, 2 nd floor break room, Pomona, CA 91766 Machines needed: (1) beverage, and (1) snack No security cages needed Page 4 of 21

2) Pomona Public Library, 625 S. Garey Ave, basement break room, Pomona, CA. Machines needed: (1) beverage, and (1) snack No security cages will be needed. 3) Pomona City Yard, 636 W. Monterey Ave, Pomona, CA 91768 Machines needed: (1) beverage and (1) snack No security cages needed. B. Requirements: 1) Vending Machine Equipment: CONTRACTOR shall operate and maintain all vending machine furnishings, equipment, and security cages at CONTRACTOR S expense. All vending machine equipment must fit and operate in designated spaces and locations. 2) Utilities Available: The City will provide necessary electrical utilities for operation of vending machines at no cost to CONTRACTOR. 3) Security Cages and Related Equipment: CONTRACTOR shall provide and maintain vending machine security cages, and all related equipment and furnishings at CONTRACTOR S expense. 4) Vandalism: CONTRACTOR may request to relocate machines, security cage equipment and furnishings due to excessive vandalism, upon consent of the City. 5) Service Calls: CONTRACTOR must respond to the CITY S all service calls within 24 hours. 6) Maintenance, Repair and Non-Operational Machines: CONTRACTOR shall service each machine at least once a week; frequency may be adjusted dependent upon volume of use. CONTRACTOR must repair inoperable machines to a fully operational condition within two (2) calendar days of services call. CONTRACTOR agrees to provide a similar replacement machine, of equal or better condition, within three (3) days after determining a machine cannot be repaired to a condition that is fully operational. 7) Stocking: Each machine must be stocked no less than once each week, and frequency may be adjusted dependent upon volume of sales at each location. The CITY may request changes in snack or beverage products at any time throughout the term of the contract. 8) Site Access: CONTRACTOR must use public or designated delivery entrances when accessing machines within City buildings. CONTRACTORS are not authorized to use City employee entrances to perform services. Page 5 of 21

9) Snack and Beverage Products: CONTRACTOR must abide by any specific Los Angeles County Health Department requirements for vending machine services for the duration of the contract term. All commission machines shall be stocked with healthy snacks and low sugar drinks per foods approved by the Los Angeles Unified School District and CA SB19 standards. All products must be of high quality beverages, pre-packaged snacks, and other items as approved by the CITY. All items shall be marked with an expiration date. Any products that melt in the sun shall not be placed in vending machines situated outside, unless the machines have an integrated cooling system. Machines with integrated cooling systems are required for all beverage machines; not required for all snack or food machines, unless as noted with products subject to melting or spoilage. CITY shall make all choices of product offered by the CONTRACTOR, and reserves the right to make changes in product selections throughout the life of the contract. The Contractor reserves to the right to provide alternative products, but product substitutions must meet all specified requirements. CONTRACTOR shall be responsible for transporting and delivering all products to stock in vending machines, and will dispose of all expired items. 10) Commission Payment Schedule: CONTRACTOR shall pay commissions to the CITY monthly, no later than the tenth (10th) day of each month for the previous calendar month, and shall provide an accounting of monthly sales for each vending machine. Monthly commission payments and accounting documentation shall be submitted to the Community Services Manager. 11) Compensation: The CITY shall not pay any compensation to the CONTRACTOR. 12) Add or Remove Locations: CITY reserves the right to add or remove locations and operations at any site during the life of the contract. 13) Space or Site Relocation: The CITY reserves the right to relocate vending machine(s) in order to maximize sales. If the CITY determines a machine(s) must be relocated, the CITY will notify the CONTRACTOR to coordinate the details of the relocation. The CONTRACTOR will be responsible for performing the removal and relocation of the machine, as well as all security cage equipment and furnishings, if applicable. Page 6 of 21

5. CONTRACT TERM 14) Hours of Operation: CITY reserves the right to specify acceptable days and hours for CONTRACTOR to restock and service machines. 15) Compliance: CONTRACTOR shall abide by all City of Pomona Ordinances, Park rules, business licensing, and Public Health food service requirements, including any specific Los Angeles County Health Department requirements for vending machine services. Any modifications or improvements to vending machine service shall be negotiated with the CITY, and will require advance written approval. 16) General Conditions: CONTRACTOR understands and agrees that the City of Pomona shall not lease or own the vending machines. CONTRACTOR shall provide vending machines at no cost to the City (excluding electrical costs). Vending machine contract(s) will only confer permission to occupy and use the premises described for vending machine purposes. CONTRACTOR S expenditure of capital and/or labor in the course of use and occupancy will not confer any interest or estate in the premises by virtue of said use, occupancy and/or expenditure of money thereon. The CITY will only grant CONTRACTOR an individual, revocable and non-transferable privilege of use in the premises for the concession granted. The Contract for services shall be for three (3) years, commencing from the date of Council award, with the option to renew for up to two (2) additional years, in one (1) year increments. 6. CONTRACT EXTENSION In the event that the City exercises its option to extend the Agreement, the City shall provide written notice to the Contractor no later than thirty (30 days) before the end of the initial term. The City s decision to exercise its option will be based upon Contractor s past performance being satisfactory to the City of Pomona. Contractor s performance will be formally reviewed on an annual basis. 7. CONTRACT TERMINATION Termination for Convenience: Either the CITY or the CONSULTANT/CONTRACTOR may terminate this AGREEMENT at any time without cause by giving thirty (30) calendar days written notice to the other of such termination and specifying the effective date thereof. If this AGREEMENT is terminated as provided herein, CONSULTANT/CONTRACTOR shall be paid only the total amount equal to the service CONSULTANT/CONTRACTOR has provided as of the termination date. In no event shall the amount payable upon termination exceed the total maximum compensation provided for in this AGREEMENT or the value of services provided as of date of termination. Termination for Cause: If for any reason, CONSULTANT/CONTRACTOR shall fail to fulfill in a timely and proper manner its obligation under this AGREEMENT, or if CONSULTANT/CONTRACTOR shall violate any of the covenants or stipulations of this Page 7 of 21

agreement, CITY shall then have the right to terminate this agreement by giving a five (5) calendar day written notice to CONSULTANT/CONTRACTOR. The notice shall refer to this clause, shall specify the nature of the alleged default, and shall specify the effective date of the termination. The CONSULTANT/CONTRACTOR will be paid a total amount equal to the service CONSULTANT/CONTRACTOR has provided as of the termination date. In no event shall the amount payable upon termination exceed the total maximum compensation provided for in this AGREEMENT. 8. REQUIRED FORMS AND ATTACHMENTS Required Forms included herein must be completed and signed by a company principal or officer, and must be returned with the Bid response. Bids submitted without the Required Forms and required attachments may be deemed as non-responsive and may be rejected. In order to maintain uniformity, bid responses must be organized and submitted using the following format: Forms: Company Summary Sheet Bid Sheet References Form Acknowledgment and Signature of Authorization Minority Business Questionnaire Statement of Non-Collusion by Contractor Agreement for Indemnification and Acknowledgment of Procurement Practices Attachments: List of snacks and beverages offered, with sale prices 9. SELECTION CRITERIA The following selection criteria will be used when evaluating bid responses and selecting the successful bidder. General Provision The award of contracts shall be at the sole discretion of the City. It is the intent to make an award to one bidder for all items, although the City reserves the right to make multiple awards depending on the needs and best interests of the City. The City may accept or reject any or all bids in whole or in parts and may waive informalities in the process. The contents of the Bid response submitted by the selected Bidder will become the basis for a contractual obligation when the award is made. Revenue Generating Services Award will be made to the highest revenuegenerating, responsive, and responsible bidder and will be based upon the information submitted in the bid response. The City may make an award without further discussion of the bids submitted; therefore, the bid response must be submitted on the most favorable terms that the Bidder can offer. Page 8 of 21

10. RESERVATION OF RIGHTS The City reserves the right to: Reject any and all bids at its discretion; Cancel the entire bid; Seek clarification of bid responses; Waive any minor errors or informalities in any bid, to the extent permitted by law. 11. TERMS AND CONDITIONS a) Addendum to the Bid If it becomes necessary to revise any part the Bid, an addendum will be posted on the City s website. If an answer materially affects the Bid, the information will be incorporated into an addendum and will be posted to the City s website for download; no other contact shall be made by the City to vendors regarding addenda to the Bid. All addenda issued during the time of bidding will be incorporated into the resulting contract. It shall be the Vendor s sole responsibility to check the City s website on a consistent basis to determine if any addenda or changes have been posted prior to the bid due date and time. b) Applicable Laws The laws of the State of California will govern the contract. The applicable law for any legal dispute arising out of the contract shall be the law of the State of California. The Bidder shall comply with all federal, state, county and local laws concerning this type of commodity/service. All systems provided by the Bidder shall comply with all applicable federal, state, and local building, fire, safety, and electrical codes and all relevant industry standards. c) Appropriation of Funds If the term of this agreement extends into fiscal years subsequent to that in which it was approved, such continuation of the contract is subject to the appropriation of funds for such purpose by the City of Pomona City Council. If funds to effect such continued payment are not appropriated, the Bidder agrees to terminate any goods or service supplied to the City under this agreement. d) Assignment The Bidder shall, under no circumstances, assign any contract issued as a result of this bid by any means whatsoever, or any part thereof to another party without express written permission of the City of Pomona. e) Award of Contract A contract may be awarded as a result of this bid and may require approval by the City of Pomona City Council as prescribed by City Ordinances and Codes. All awarded contracts must be issued a City of Pomona Purchase Order prior to delivering goods or performing services. If the awarded vendor imposes additional terms or conditions after the award of a contract, the award may be rescinded and the Contract will be canceled. f) Bidder's Cost to Develop a Response Costs for developing a response to this solicitation are entirely the obligation of the Bidder and shall not be chargeable in any manner to the City of Pomona. Page 9 of 21

g) Conflict of Interest Except for items that are clearly promotional in nature, mass produced, trivial in value and not intended to invoke any form of reciprocation, employees of the City of Pomona may not accept gratuities, entertainment, meals of anything of value whatsoever from current or potential suppliers. The offer of such gratuity to an employee of the City shall be cause for declaring such supplier to be an irresponsible bidder and will be prevented from bidding as provided in Sections 2-974 and 2-975 of the City Code of the City of Pomona. h) Current Revenue Payments Bidders shall be current with payments due to the City on any and all contracts, including but not limited to revenue generating contracts, in order to be eligible for bid submission. Bidders who are not current with payments on any and all City of Pomona contracts may be considered nonresponsible and may not be considered for award. i) Default Of Vendor - The City of Pomona shall hold the Vendor responsible for any damage, which may be sustained because of the failure or neglect of the vendor to comply with any term or condition, listed herein. j) Equal Employment Opportunity The Bidder shall comply with all applicable state and federal laws addressing Equal Employment Opportunity. k) General Services Award will be made to the lowest, responsive, and responsible bidder. The City may make an award without further discussion of the bids submitted; therefore, the bid should be submitted with the most favorable terms that the Bidder can offer. l) Independent Contractor Status It is expressly understood that the Bidder named in any contract entered into by the City is acting as an independent contractor and not as an agent or employee of the City of Pomona. m) Late Submission of Bid Any bids received after the due date and time specified in this bid will not be accepted. The City will not return late submittals. Late submittals will be destroyed by the City 30 days after bid opening. n) News Releases The Bidder shall not make news releases pertaining to an award resulting from bids made in response to the bid without the prior written approval of the City of Pomona Finance Director. In addition, the successful Bidder must agree not to release any advertising copy mentioning the City of Pomona or quoting the opinion of any City employee without written approval by the City of Pomona Finance Director. o) Permits and Licenses The Bidder shall secure or maintain in force during the period covered by any contract resulting from this specification all licenses and permits required by law for the operation of their business including a Pomona Business License when required. p) Public Information After the date specified for the opening of the bid, all materials received relative to general service bids become public information and are available for inspection. Professional service bids become public upon award of contract. The City Page 10 of 21

reserves the right to retain all bids submitted, whether or not the bid was selected or judged to be responsive. q) Rejection of Bids This bid does not commit the City of Pomona to award any contract. The City reserves the right, at its sole discretion, to reject any or all bids without penalty, to waive irregularities in any bid response or in the bid procedures, and to be the final judge in determining a responsive and responsible bid. The City reserves the right, at its sole discretion, to reject any or all bids that include items not specified, incorrect specifications and/or scope of services, incomplete schedule of required items, additional terms and conditions, and bids that do not respond to the published specifications and/or scope of services. Bids received by telephone or facsimile will be considered non-responsive and will be rejected. Bids offering less than 90 days for acceptance from the published closing date may be considered non-responsive and may be rejected. r) Signatures Bid responses must be signed in longhand by the Bidder with his/her usual signature in the designated areas within the bid documents. Submission of bids must be signed by any and all representatives legally authorized to contractually bind the Corporation. s) Unauthorized Use of City Seal or Logo Section 2-5(3)a of the Pomona City Code prohibits the use of the City s Seal or Logo, or any reproduction thereof, for any purpose other than for official business of the city, its council, officers or departments. t) Withdrawal of Bids Bid responses received by the Purchasing Division may be withdrawn. An authorized representative of the Bidder must submit a signed, written request to the Purchasing Manager, formally requesting their bid to be withdrawn from the bid process. 12. INSURANCE REQUIREMENTS A. INDEMNITY Consultant/Contractor/Vendor hereby agrees to indemnify, including the cost to defend City of Pomona, and its officers, officials, agents, employees, and volunteers, from any and all losses, claims, liens, demands, liability, and causes of action of every kind and character including, but not limited to, the amounts of judgment, interests, court costs, legal fees, expert costs, expert fees and other all expenses incurred by the City of Pomona to the maximum extent allowed by law arising in favor of any party, that arise out of, or pertain to, or relate to the negligence, recklessness, or willful misconduct of Consultant/Contractor/Vendor and its agents in the performance of services under this contract, but this indemnity does not apply to liability for damages for death or bodily injury to persons, injury to property, or other loss, arising from the sole negligence, willful misconduct or defects in design by the City of Pomona or the agents, servants, or independent contractors who are directly responsible to City of Pomona, or arising from the active negligence of City of Pomona. B. INSURANCE Page 11 of 21

The CONSULTANT/CONTRACTOR shall maintain throughout the duration of the term of the Agreement, liability insurance covering the CONSULTANT/CONTRACTOR and designating CITY including its elected or appointed officials, directors, officers, agents, employees, volunteers, or consultants, as additional insured against any and all claims resulting in injury or damage to persons or property (both real and personal) caused by any aspect of the CONSULTANT's/CONTRACTOR s work, in amounts no less than the following and with such deductibles as are ordinary and reasonable in keeping with industry standards. It shall be stated, in the Additional Insured Endorsement, that the CONSULTANT's/CONTRACTOR s insurance policies shall be primary as respects any claims related to or as the result of the CONSULTANT's/CONTRACTOR s work. Any insurance, pooled coverage, or self-insurance maintained by the CITY, its elected or appointed officials, directors, officers, agents, employees, volunteers, or consultants shall be noncontributory. The Additional Insured Endorsement shall not apply to the Professional Liability Insurance. Professional Liability Insurance (applies only to professional service contract): a. General Aggregate $2,000,000 General Liability: a. General Aggregate $2,000,000 b. Products Comp/Op Aggregate $2,000,000 c. Personal & Advertising Injury $1,000,000 d. Each Occurrence $1,000,000 e. Fire Damage (any one fire) $ 50,000 f. Medical Expense (any one person) $ 5,000 Workers' Compensation: a. Workers' Compensation Statutory Limits b. EL Each Accident $1,000,000 c. EL Disease - Policy Limit $1,000,000 d. EL Disease - Each Employee $1,000,000 Automobile Liability a. Any vehicle, combined single limit $1,000,000 The CONSULTANT/CONTRACTOR shall provide thirty (30) days advance notice to CITY in the event of material changes or cancellation of any coverage. Certificates of insurance and additional insured endorsements shall be furnished to CITY thirty (30) days prior to the effective date of this Agreement. Refusal to submit such certificates shall constitute a material breach of this Agreement entitling CITY to any and all remedies at law or in equity, including termination of this Agreement. If proof of insurance required under this Agreement is not delivered as required or if such insurance is canceled and not adequately replaced, CITY shall have the right but not the duty to obtain replacement insurance and to charge the CONSULTANT/CONTRACTOR for any premium due for such coverage. CITY has the option to deduct any such premium from the sums due to the CONSULTANT/CONTRACTOR. Page 12 of 21

Insurance is to be placed with insurers authorized and admitted to write insurance in California and with a current A.M. Best's rating of A-:VII or better. Acceptance of insurance from a carrier with a rating lower than A-:VII is subject to approval by CITY's Risk Manager. CONSULTANT/CONTRACTOR shall immediately advise CITY of any litigation that may affect these insurance policies. C. CHANGES The Consultant/Contractor shall provide thirty (30) days advance notice to CITY in the event of material changes or cancellation of any coverage. Certificates of insurance and additional insured endorsements shall be furnished to CITY thirty (30) days prior to the effective date of this Agreement. Refusal to submit such certificates shall constitute a material breach of this Agreement entitling CITY to any and all remedies at law or in equity, including termination of this Agreement. If proof of insurance required under this Agreement is not delivered as required or if such insurance is canceled and not adequately replaced, CITY shall have the right but not the duty to obtain replacement insurance and to charge the Consultant/Contractor for any premium due for such coverage. CITY has the option to deduct any such premium from the sums due to the Bidder. Insurance is to be placed with insurers authorized and admitted to write insurance in California and with a current A.M. Best's rating of A-:VII or better. Acceptance of insurance from a carrier with a rating lower than A-:VII is subject to approval by City s Risk Manager. 13. DEFINITIONS In accordance with Section 2-961 of the Pomona City Code, the following words, terms and phrases have the meanings ascribed to as follows: Nonresponsive bidder means an offer, submitted by a bidder, to furnish supplies, equipment or services that are not in conformity with the specifications, delivery terms or conditions or other requirements specified in the invitation for bids. Nonresponsible bidder is a bidder that provides a bid but fails to demonstrate their capacity (financial or otherwise) to provide the supplies, equipment or service as specified in the bid. Responsible bidder means a bidder who submits a responsive bid and who is not only financially responsible, but also possesses the resources, judgment, skill, ability, capacity and integrity requisite and necessary to perform the contract according to its terms. Responsive bid means a bid, submitted by a responsible bidder, to furnish supplies, equipment or services in conformity with the specifications, delivery terms and conditions and other requirements specified in the invitation for bids. Services means any and all services, including but not limited to the repair or maintenance of equipment, machinery and other property. This term does not include services rendered by city officers or employees or architectural or other professional services, which by their nature do not lend themselves to normal competitive procedures. Page 13 of 21

THE FOLLOWING FORMS ARE REQUIRED TO BE SUBMITTED WITH BID Page 14 of 21

14. COMPANY SUMMARY SHEET Company Name: Company Address: Company Telephone Number: Fax Number: How long has this company been in business? Bid Contact (person responsible for answering questions related to the Bid response): Name: Telephone Number: Title: Fax: Email: Management Contact (person responsible for making decisions related to the Contract): Name: Telephone Number: Title: Fax: Email: Contract/Account Manager (Person responsible for day-to-day servicing of the Contract/account): Name: Telephone Number: Title: Fax: Email: Page 15 of 21

15. BID SHEET Percentage of gross revenue to be paid to the City for the commissioned machines: Page 16 of 21

16. REFERENCES Provide three (3) current or previous, municipal or government entity references that are comparable to the size of the City of Pomona for which services are currently, or were performed. Services performed must be like or similar to the scope of services/specifications published herein. References should be for services performed within the past five (5) years. 1. Company Name Address City State Zip Telephone Email Number of years services were performed or are currently performed: Number of vending machines at this company 2. Company Name Address City State Zip Contact Name and Title: Telephone Email Number of years services were performed or are currently performed: Number of vending machines at this company 3. Company Name Address City State Zip Contact Name and Title: Telephone Email Number of years services were performed or are currently performed: Number of vending machines at this company Page 17 of 21

17. ACKNOWLEDGEMENT AND SIGNATURE OF AUTHORIZATION I, have read and understand the (Full Printed Name) (Title) the bid document, and I am duly authorized to commit my company to sell/perform the products/services described herein. I understand by signing this bid I am not obligating the City to make this procurement, nor am I signing a contract to sell/perform this product/service. By signing this document I agree to comply with all specifications, scope of services, requirements, terms and conditions described herein, unless specifically noted. This bid is firm for 90 days from the due date identified on the cover page of this Bid. Authorized Representative: Signature Date Page 18 of 21

18. CITY OF POMONA MINORITY BUSINESS QUESTIONNAIRE Failure to complete and submit this Worksheet with the Bid response will render the Bid non-responsive and will not be considered for award. Name of Business: Division or Subsidiary, if applicable: Business Address: Business Telephone No.: Contact Person: Title: Type of Business: Non Profit [ ] Sole Proprietorship [ ] Partnership General [ ] Limited [ ] Corporation [ ] Is the business 51% or more owned by: American Indian [ ] Asian [ ] Black [ ] Hispanic [ ] Female [ ] Other [ ] (please specify) Prepared By: Title: Date: For more information, please contact the City of Pomona Purchasing Division (909) 620-2381. Page 19 of 21

19. CITY OF POMONA STATEMENT OF NON-COLLUSION BY CONTRACTOR Failure to complete and submit this Worksheet with the Bid response will render the Bid non-responsive and will not be considered for award. The undersigned who submits herewith to the City of Pomona a Bid or proposal does hereby certify that: a. All statements of fact in such bid or proposal are true; b. Such bid or proposal was not made in the interest of or on behalf of any undisclosed person, partnership, company, association, organization or corporation; c. Such bid or proposal is genuine and not collusive or sham; d. Bidder has not, directly or indirectly by agreement, communication or conference with anyone, attempted to induce action prejudicial to the interest of the City of Pomona or of any other bidder or anyone else interested in the proposed procurement; e. Bidder did not, directly or indirectly, collude, conspire, connive or agree with anyone else that said bidder or anyone else would submit a false or sham bid or proposal, or that anyone should refrain from bidding or withdraw his bid or proposal; f. Bidder did not, in any manner, directly or indirectly seek by agreement, communication or conference with anyone to raise or fix the bid or proposal price of said bidder or of anyone else, or to raise or fix any overhead, profit or cost element of his bid or proposal price, or that of anyone else; g. Bidder did not, directly or indirectly, submit his bid or proposal price or any breakdown thereof, or the contents thereof, or divulge information or data relative thereto, to any corporation, partnership, company, association, organization, bid depository, or to any member agent thereof, or to any individual or group of individuals, except to the City of Pomona, or to any person or persons who have a partnership or other financial interest with said bidder in his business. h. Bidder did not provide, directly or indirectly to any officer or employee of the City of Pomona any gratuity, entertainment, meals, or anything of value, whatsoever, which could be construed as intending to invoke any form of reciprocation or favorable treatment. i. No officer or principal of the undersigned firm is employed or has been employed, either full or part time, by the City of Pomona, either currently or within the last two (2) years, or is related to any officer or employee of the City by blood or marriage within the third degree. An exception to this section may be granted by approval of the City Council prior to contract award. j. No officer or principal of the undersigned firm nor any subcontractor to be engaged by the principal has been convicted by a court of competent jurisdiction of any charge of fraud, bribery, collusion, conspiracy or any other act in violation of any state or federal antitrust law in connection with the bidding on, award of, or performance of, any public work contract, with any public entity, within the last three years. I certify, under penalty of perjury under the laws of the State of California, that the foregoing is true and correct and that this certification was executed on at, (Date) (Location) California. Business: By: Address: (Signature) (Print Name & Title) Page 20 of 21

20. CITY OF POMONA AGREEMENT FOR INDEMNIFICATION BY CONTRACTOR/VENDOR AND ACCEPTANCE AND ACKNOWLEDGMENT OF PROCUREMENT PRACTICES OF THE CITY OF POMONA Failure to complete and submit this Worksheet with the Bid response will render the Bid non-responsive and will not be considered for award. The City of Pomona requires contractors and suppliers of services to the City to agree to indemnify and hold the City of Pomona harmless for claims or losses arising from, or in connection with, the contracting party s work for the City of Pomona before a Purchase Order is issued. To reduce the possibility of misunderstanding between contracting parties and the City in case of a claim or lawsuit, the City of Pomona is requiring that contacting parties who perform services for the City sign this letter. This letter will act as and become a part of each Contract/Purchase Order between the City of Pomona and the contracting parties signing the letter for the duration of the contract term and any extensions thereto. In consideration of the opportunity of doing work for the City of Pomona and benefits to be received thereby, the contracting party to this agreement agrees as follows: 1. That where a contract, purchase order or confirming order is issued by the City of Pomona awarding a contract, this Letter Agreement is to be considered part of that contract. 2. Contractor agrees to indemnify the City of Pomona, and any officer, employee or agent, and hold the City of Pomona, and any officer, employee or agent, thereof harmless from any and all claims, liabilities, obligations and causes of action, of whatsoever kind or nature, for injury to, or death of, any person (including officers, employees and agents of the City of Pomona), and for injury or damage to or destruction of property (including property of the City of Pomona), resulting from any and all actions or omissions of contractor or contractor s employees, agents or invitees, or any subcontractor of contractor or any of such subcontractor s employees, agents or invitees. 3. That the contracting party specifically waives the benefits and protection of Labor Code Section 3864 which provides: If an action, as provided in this chapter, is prosecuted by the employee, the employer, or both jointly against the third person results in judgment against such third person or settlement by such third person, the employer shall have no liability to reimburse or hold such third person harmless on such judgment or settlement in the absence of a written agreement so to be executed prior to the injury. This waiver will apply to the contracting party to this letter to any contracts awarded by the City of Pomona during the term of this Agreement and any extensions thereto. 4. That this Agreement has been signed by an authorized representative of the contracting party, and such representative has the authority to bind the contractor/vendor to all terms and conditions of this Agreement. 5. That this Agreement shall be binding upon the successors and assignees of the contracting party to any contract with the City of Pomona. As a condition precedent to acceptance, any contacts from the City of Pomona and contracting party agree to advise its successors or assignees of this Agreement and to obtain their consent to it in writing before the work of the representative successor or assignees begins. Such assignment shall not be effective without the prior written consent of the City of Pomona. 6. To promptly notify the City of Pomona of any change in ownership of the contracting party while this Agreement is in force. This letter Agreement cannot be modified or changed without the express written consent of the City of Attorney of the City of Pomona. I agree to the terms of this Letter Agreement on behalf of: Business: Address: Date: By: (Signature) (Print Name & Title) Page 21 of 21