Loading...
HomeMy WebLinkAboutLodge Construction, Inc.r, C.7.: ,7 ,,) CO r„";y IND CZ) rri w..4 ha PD. 1ox459 1 CuiRmui, IA30619 BID BOND KNOW ALL MEN BY THESE PRESENTS, that we, Lodge Construction, Inc. as Principal, and North American Specialty Insurance Company as Surety are held and firmly bound unto the CITY OF WATERLOO , Iowa, hereinafter called "OWNER." In the penal sum Five Percent of Amount Bid Dollars ($ 5% ) lawful money of the United States, for the payment of which sum will and truly be made, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally, firmly by these presents. The condition of this obligation is such that whereas the Principal has submitted the accompanying bid date_ d the 13th day of , July ,2017 , for FY 2018 Manhole Inspections - Service Areas 10, 11, 12 and 13 in the City of Waterloo, IA - Contract No. 935 NOW, THEREFORE, (a) If said Bid shall be rejected, or in the alternate, (b) If said Bid shall be accepted and the Principal shall execute and deliver a contract in the form specified and shall furnish a bond for his faithful performance of said contract, and for the payment of all persons performing labor or furnishing materials in connection therewith, and shall in all other respects perform the agreement created by the acceptance of said Bid, Then this obligation shall be void, otherwise thesame shall remain in force and effect; it being expressly understood and agreed that the liability of the Surety for any and all claims hereunder shall, in no event, exceed the penal amount of this obligation as herein stated. By virtue of statutory authority, the full amount of this bid bond shall be forfeited to the Owner in liquidation of damages sustained in the event that the Principal fails to execute the contract and provide the bond as provided in the specifications or by law. The. Surety, for value received, hereby stipulates and agrees that the obligations of said Surety and its bond shall be in no way impaired or affected by any extension of the time within which the Owner may accept such Bid or execute such contract; and said Surety does hereby waive notice of any such extension. IN WITNESS WHEREOF, the Principal and the Surety, have hereunto set their hands and seals, and such of them as are corporations, have caused their corporate seals to be hereto affixed and these pres- ents to be signed by their proper officers this 5th day of July A.D. 2017 . Witness Witness i,Jidy Bennett BID BOND AECOM 60543369 Lodge Construction, Inc. North Ameri Surety G (Seal) n specialty Insurance Company (Seal) cr Attorney-in-fact Anne Crowner, Attorney-in-fact CONTRACT NO. 935 BB -1 OF 1 NAS SURETY GROUP NORTH AMERICAN SPECIALTY INSURANCE COMPANY WASHINGTON INTERNATIONAL INSURANCE COMPANY GENERAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS, THAT North American Specialty Insurance Company, a corporation duly organized and existing under laws of the State of New Hampshire, and having its principal office in the City of Manchester, New Hampshire, and Washington International Insurance Company, a corporation organized and existing under the laws of the State of New Hampshire and having its principal office in the City of Schaumburg, Illinois, each does hereby stake, constitute and appoint: JAY D. FREIERMUTII, CRAIG E. HANSEN, BRIAN M. DEIMERLY, SHIRLEY S. BARTENHAGEN, CINDY BENNETT, ANNE CROWNER, TIM McCULLOII, STACY VENN, LACEY CRAMBLIT and DIONE R. YOUNG JOINTLY OR SEVERALLY Its true and lawful Attorney(s)-in-Fact, to stake, execute, seal and deliver, for and on its behalf and as its act and deed, bonds or other writings obligatory in the nature of a bond on behalf of each of said Companies, as surety, on contracts of suretyship as are or may be required or permitted by law, regulation, contract or otherwise, provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the amount of: FIFTY MILLION ($50,000,000.00) DOLLARS This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors of both North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held on the 9th of May, 2012: "RESOLVED, that any two of the Presidents, any Managing Director, any Senior Vice President, any Vice President, any Assistant Vice President, the Secretary or any Assistant Secretary be, and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named in the given Power of Attorney to execute on behalf of the Company bonds, undertakings and all contracts of surety, and that each or any of them hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein Ole seal of the Company; and it is FURTHER RESOLVED, that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be binding upon the Company when so affixed and in the future with regard to any bond, undertaking or contract of surety to which it is attached." oututmoof `v SEAL 'lora o Pu5t .,.2d107a aegm' Steven P. Anderson, Senior Via Pre,%dent of Washington International Insurance Company & Senior Vice President of North American Specialty Insurance Company .iNAda By Michael A. lto, Senior Vice President of as ngton International Insurance Company �paranaunr� & Senior Vice President of North American Specialty Insurance Company By'�- IN WITNESS WHEREOF, North American Specialty insurance Company and Washington International Insurance Company have caused their official seals to be hereunto affixed, and these presents to be signed by their authorized officers this 8th day of September , 20 15 . State of Illinois County of Cook ss: North American Specialty Insurance Company Washington International Insurance Company On this 8th day of September , 2015 , before me, a Notary Public personally appeared Steven P. Anderson Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and Michael A. Ito Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company, personally known to rne, who being by me duly sworn, acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the voluntary act and deed of their respective companies. OFFICIAL SEAL M KENNY NOTARY PUBLIC, STATE OF IW NOIS MY COMMISSION EXPIRES 12/0912017 M. Kenny, Notary Public s, I, Jeffrey Goldberg the duly elected Assistant Secretary of North American Specialty Insurance Company and Washington International Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney given by said North American Specialty Insurance Company and Washington International Insurance Company, which is still in full force and effect. IN WITNESS WHEREOF, 1 have set my hand and affixed the seals of the Companies this 5th day oo�oJff July , 2017 Jeffrey Goldberg, Vice President & Assistant Secretary of \Vmhinglon International Insurance Company Sr North America, Specialty Insurance Company FORM OF BID OR PROPOSAL FY 2018 MANHOLE INSPECTIONS — SERVICE AREAS 10, 11, 12 AND 13 CITY OF WATERLOO, IOWA CITY CONTRACT NO. 935 Honorable Mayor and City Council Waterloo, Iowa Gentlemen: 1. The undersigned, being a Corporation existing under the laws of the State of :779-, a Partnership consisting of the following partners: having familiarized (himself) (themselves) (itself) with the existing conditions on the project area affecting the cost of the work, and with all the contract documents listed in the Table of Contents and Addenda (if any), as prepared by the City Engineer of the City of Waterloo now on file in the office of the City Clerk, City Hall, Waterloo, Iowa, hereby proposes to furnish all supervision, technical personnel, labor, materials, machinery, tools, appurtenances, equipment, and services, including utility and transportation services required to construct and complete this FY 2018 MANHOLE INSPECTIONS — SERVICE AREAS 10, 11, 12 AND 13, CITY CONTRACT NO. 935, all in accordance with the above -listed documents and for the unit prices for work in place for the following items and quantities: FY 2018 MANHOLE INSPECTIONS — SERVICE AREAS 10, 11, 12 AND 13 CITY OF WATERLOO, IOWA CITY CONTRACT NO. 935 Item Description Unit Estimated Quantiles Unit Price Total Amount 1 Manhole Inspection - SA 10 EA 346.00 $ 175— :`' $ t)S s u 2 Manhole Inspection - SA 11 EA 347.00 $ / 75 ` $ 40)2;25''` 3 Manhole Inspection - SA 12 EA 140.00 $ j7.5" _= $ a o 5— ' c1.1- =4 4 Manhole Inspection - SA 13 EA 43.00 $ ) r ea $ 7.1 > .°'— TOTAL BID $ a /S3, 300 2. It is understood that the quantities set forth are approximate only and subject to variation and that the unit bid price for the work done shall govern in the actual payment to Contractor. 3. In submitting this bid, the bidder understands that the right is reserved by the City of Waterloo, Iowa, to reject any or all bids. If written notice of the acceptance of this bid is mailed, telegraphed, or delivered to the undersigned within thirty (30) days after the opening thereof, or at any time thereafter before this bid is withdrawn, the undersigned agrees to execute and deliver an agreement in the prescribed form and furnish the required bond and certificate of the insurance within ten (10) days after the agreement is presented to him for signature, and start work within ten (10) days after "Notice to Proceed" is issued. VCo 4. Security in the sum of Dollars ($ ) in the form of lec.Ke4✓ , is submitted herewith in accordance with the INSTRUCTIONS TO BIDDERS. 5. Attached hereto is a Non -Collusion Affidavit of Prime Contractor. FORM OF BID AECOM 60543369 CONTRACT NO. 935 BF -1 OF 2 6. Attached hereto is a Resident Bidder Certification ( ). (Mark one.) or Non -Resident Bidder Certification 7. The bidder is prepared to submit a financial and experience statement upon request. 8. The Prime Contractor and Subcontractor(s), which have performed an aggregate of $10,000.00 in work for the City in the current calendar year, are prepared to submit an AAP or Update and an EOC, within ten (10) days of notification that the bid submitted is lowest and acceptable. 9. The bidder has received the following Addendum or Addenda: Addendum No. Date 10. The bidder shall list the MBEM/BE subcontractor(s), amount of subcontracts and bid items on the City of Waterloo Minority and/or Women Business Pre-bid Contact Information Form submitted with this Form of Bid or Proposal. The apparent low Bidder shall submit a list of all other Subcontractor(s) to be used on this Project to the City of Waterloo by 5:00 p.m. the business day following the day Bids on this Project are due along with the Non -Collusion Affidavits of All Subcontractor(s). The Contractor shall submit information on subcontractors on "SUBCONTRACTOR REQUEST AND APPROVAL" Form to be provided by City prior to approval of contract. The subcontractors listed on this proposal and/or submitted to the Contract Compliance Officer cannot be changed except for the following reasons: 1) The City of Waterloo does not approve the subcontractors. 2) The subcontractors submit in writing that they cannot fulfill their subcontracts. 11. The bidder has filled in all blanks on this proposal. Those blanks not applicable are marked "none" or "NA". 12. The bidder has attached all applicable forms. 13. The Owner reserves the right to select alternates, delete line items, and/or to reduce quantities prior to the award of a contract due to budgetary limitations. BY: 26,ti,9% (nen51nic.41 (N n of Bidder) Official Address: (Including Zip Code): 1-0- 882( ys"1 c JICsvllli ) {{-`- % I.R.S. No. 177"c2' 5 g/ FORM OF BID AECOM 60543369 TitleX57/12 .r 7 -13 - (Date) CONTRACT NO. 935 BF -2 OF 2 NON -COLLUSION AFFIDAVIT OF PRIME BIDDER State of n )ss County of /3/s -c /= /A - 41- 5c 5c being first duly sworn, deposes //and says that: 1. He is (Owner, Partner, Officer ep"resentative)or Agent) , of `-• el; c rcostn.c 1.v'.- the Bidder that has s brnitted-the-attached Bid; 2. He is fully informed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid; 3. Such Bid is genuine and is not a collusive or sham Bid; 4. Neither the said Bidder nor any of its officers, partners, owners, agents, representatives, employees, or parties in interest, including this affiant, has in any way colluded, conspired, connived or agreed, directly or indirectly, with any other Bidder, firm or person to submit a collusive or sham Bid in connection with the Contract for which the attached Bid has been submitted or to refrain from bidding in connection with such Contract, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or conference with any other Bidder, firm or person to fix the price or prices in the attached Bid or of any other Bidder, or, to fix any overhead, profit or cost element of the bid price or the bid price of any other Bidder, or to secure through any collusion, conspiracy, connivance, or unlawful agreement any advantage against the City of Waterloo, Iowa, or any person interested in the Proposed Contract; and 5. The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the Bidder or any of its agents, representatives, owners, employees, or parties in interAt, including thi affiant. (Signed) .571 Title Subscribed and sworn to before me this /.37'Xr day of My commission expires eiA< m ti , 201. LINDA K SENN COMMISSION NO. 803307 MY COMttlISSION EXPIRES NON -COLLUSION CONTRACT NO. 935 NCA -1 OF 2 AECOM 60543369 EQUAL OPPORTUNITY CLAUSE (As provided in Executive Order No. 11246) All contractors, subcontractors, vendors and suppliers of goods and services doing business with the City and value of said business equals or exceeds ten thousand dollars ($10,000.00) annually agree as follows: 1. The contractors, subcontractor, vendor and supplier of goods and services will not discriminate against any employee or applicant for employment because of race, color, creed, sex, national origin, economic status, age, mental or physical handicap, political opinions or affiliations. The contractor, subcontractor, vendor and supplier will develop an Affirmative Action program to ensure that applicants are employed and that employees are treated during employment without regard to their race, creed, color, sex, national origin, religion, economic status, age, mental or physical disability, political opinions or affiliations. Such actions shall include but not be limited to the following: a. Employment b. Upgrading c. Demotion or Transfer d. Recruitment and Advertising e. Layoff or Termination f. Rates of Pay or Other Forms of Compensation g. Selection for Training Including Apprenticeship 2. The contractor, subcontractor, vendor and supplier of goods and services will, in all solicitations or advertisements for employees, state that all qualified applicants will receive consideration for employment without regard to race, creed, color, sex, national origin, religion, economic status, age, mental or physical disabilities, political opinion or affiliations. 3. The contractor, subcontractor, vendor and supplier or his/her collective bargaining representative will send to each labor union or representative of workers which he/she has a collective bargaining agreement or other contract or understanding, a notice advising said labor union or workers' representative of the contractor's commitment under this section. 4. The contractor, subcontractor, vendor and supplier of goods and services will comply with all published rules, regulations, directives, and order of the City of Waterloo Affirmative Action Program Contract Compliance Provisions. 5. The contractor, subcontractor, vendor and supplier of goods and services will furnish and file compliance reports within such time and upon such forms as provided by the Affirmative Action Officer. Said forms will elicit information as to the policies, procedures, patterns, and practices of each subcontractor as well as the contractor himself/herself and said contractor, subcontractor, vendor and supplier will permit access to his/her employment books, records and accounts to the City's Affirmative Action Officer, for the purpose of investigation to ascertain compliance with this contract and with rules and regulations of the City's Affirmative Action Program—Contract Compliance Provisions relative to Resolution No. 24664. 6. In the event of the contractor's non-compliance with the non-discrimination clauses of this contract or with any of such rules, regulations and orders, this contract may be canceled, terminated or suspended in whole or in part and the contractor may be declared ineligible for further contracts in accordance with procedures authorized by the City Council. 7. The contractor, subcontractor, vendor and supplier of goods and services will include, or incorporate by reference, the provisions of the non-discrimination clause in every contract, EQUAL OPPORTUNITY CLAUSE AECOM 60543369 CONTRACT NO. 935 EOC-1 of 2 subcontract or purchase order unless exempted by the rules, regulations or orders of the City's Affirmative Action Program, and will provide in every subcontract, or purchase order that said provisions will be binding upon each contractor, subcontractor, or supplier. 8. We, the undersigned, recognize that we are morally and legally committed to non-discrimination in employment. Any person who applies for employment with our company will not be discriminated against because of race, creed, color, sex, national origin, economic status, age, mental or physical disabilities. (7 EQUAL OPPORTUNITY CLAUSE AECOM 60543369 (Signed) e .. ([Appropriate Official) (Title) `x—/3 —/2' (Date) CONTRACT NO. 935 EOC-2 of 2 CONTRACT NO: PROJECT NAME: DATE OF LETTING: RESIDENT BIDDER CERTIFICATION 933 J C'>'3 l /,?"/7 To be a qualified resident bidder, the bidder shall be a person or entity authorized to transact business in this state and having a business for at least three years prior to the date of the first advertisement for the public improvement. If another state or foreign country has a more stringent definition of a resident bidder, the more stringent definition is applicable as to bidders from that state or foreign country. This qualification as resident bidder shall be maintained by the contractor and his subcontractors at the work site until this project is completed. I hereby certify that I am a resident bidder as defined above. RESIDENT BIDDER AECOM 60543369 COMPANY NAME ` d5 (c s -f r'c 41 -- CORPORATE -1 -- CORPORATE OFFICER S -lzuZ ivelf TITLE c01--- t4- 3 DATE CONTRACT NO. 935 RB -2 OF 3 Revised February 2003 CONTRACTOR'S OR SUBCONTRACTOR'S AFFIRMATIVE ACTION PROGRAM Check box that applies to party completing program: ( )General Contractor ( ) Subcontractor I. Section A to be completed by GENERAL CONTRACTORS only: A. Name of Company /oe. ('c t5 -)r-t- f f Address of CompanyP.4" 23'/ 61 c//h )Ie - 11 Zip se/a//� Telephone Number (2 I ) ,,_3 '2 — (27,0 Federal ID Number (if no Federal ID Number, Owner/President's Social Security Number) //7, (72 ail gcf, 49 Name of Project /Y (2'YYY b` I e Project Contract Number 93 S it's pee - Estimated Construction Work Dates C 7-17 7 / l -;)3'0 Start Finish Section B to be completed by SUBCONTRACTORS only: B. Name of General or Prime Contractor Name of Subcontractor Subcontractor's Address Zip Subcontractor's Telephone Number ( Subcontractor's Federal ID Number (if no Federal ID Number Owner/President's Social Security Number) Name of Equal Employment Officer C. Remainder of program to be completed by party completing program, either Prime or Subcontractor. -1 - 1. The Owners and/or Principals of your company: Name Address )4', A dSa P4'- 130/«511' L lcr k3,41/e; 479- Position 3,41 / ym- Position Ethnic Sex Origin ,4/1 it/ 2. Other Areas of Interest: If your company has branches or subsidiaries, or if your company is a branch or subsidiary of a parent organization, give the following information: Name Type of Address Affiliation Degree II. EMPLOYER'S POLICY (Please read carefully.) A. We, the undersigned, recognize that we are morally and legally committed to nondiscrimination in employment. Any person who applies for employment with our company will not be discriminated against because of race, color, creed, sex, national origin, economic status, age, mental or physical handicap. B. The employment policies and practices of the undersigned are to recruit and hire employees without discrimination, and to treat them equally with respect to compensation and opportunities for advancement, including training, upgrading, promotion, and transfer. However, we realize the inequities associated with employment training, upgrading, contracting and subcontracting for minorities and women and we will direct our efforts to correcting any deficiencies to the maximum extent possible. The same will be required of our SUBCONTRACTORS and suppliers. C. We submit this program to assure compliance with Executive Order 11246, as amended, and other subsequent orders that may pertain to equal employment opportunity and merit employment policies, fully realizing that our qualification and/or merit system should be evaluated and revised, if necessary. D. We agree to put forth the maximum effort to achieve full employment and utilization of capabilities and productivity of all our citizens without regard to race, creed, color, sex, national origin, economic status, age, and mental or physical handicap. E. will give training (Name of Company) and employment opportunities to greatest extent feasible. III. AFFIRMATIVE ACTION A. B. C. D. dents of Waterloo, Iowa, to the LODGE CON CTR 1TrTIcmjti Ikir^ ( - ;'., o • 1st: _.�.._.. .. effective application of a polic • - -,,: • glifinv policy statement, and (Name of Company) will, therefore, re-evaluate -: irmative Action employment opportunities lable on the actively encourage minorl _=li.' en and local re1911.160k4591 with our company on r that the n just a C; N; s rv.;LJC TI • r i'1i•1....-. ■ on e r will undertake the following six ^ CO'1 TRT I(T:GJi Nc. i a Action Program: RO. Box 4591 CLkaxswLLE, IA 50619 1. Minority Recruitment and Employment; 2. Local Recruitment and Employment; 3. Disabled Veteran an -tnam Era Veteran Recruitment and Employment; i�'i,�,� 4. Handicapped Recruitm '"!ili ployment; 5. Female Recruitment - a? -- i,': menta and 6. Training, Up `•^.rtunities. ?% NC ;I. whatever steps a CG1451e4:iie Mom 4'•'snti`- •tal work force has adequate minority, female, and loca replr - . • ' -will utilize the following methods in our recruitment attempts: will take 1. Local advertising media (newspapers, radio, TV); 2. Community organizati. ( rches, clubs, schools); 3. Public and private in,r t; in the area (UNI, Hawkeye Community College); 4. Job Service of lo 5 Other. Ewill seek qualified minority, fiT'l;4j INC. female, and loca DOp®gx�yi �i a- gories and will make asserted efforts to increase minority, female and group representation in occupations at the higher levels or skill and responsibility. E. All sources of employment used shall be aware that we are an Equal Employment Opportunity Employer. Labor organizations representing our employees will be notified of our Equal Employment Opportunity Policy and Affirmative Action Program. -3 - F. Training, upgrading, promot monitored to ensure that full female, and local gr G. ransfer activities at all levels will be ion has been given to qualified minority, companies wit and we will a L CoN5Irktt< will encourage other do business, to do the same H. has taken the following pany) minority, female, local contractors and/or ies to negotiate and/or bid on this project: (if J. 2. P,ivtc. o As a result of the above efforts, we have involved minority, female, and local contractors and/or suppliers in the following areas of subcontracting: (if none, write "NONE") 2. Affirmative Action Pr. '`.0,Ntm IOC, -ctors who propose to work on this project and wi"..9l oxv9$iejt : . 77kri : -ssary to ensure that non - minority contractors have adequate representation of minority, female and local persons in their total work force. will require approved K. In further accordance with rules Order 11246 as amended, we e parity percentages sup.lied reviewed on an annua L. lines issued pursuant to Executive e goals for our company, based on we realize these goals will be will keep records of specific actions relativitudloae4314121iitPicsvitiERSea, training, upgrading and promotion and will provide the City of Waterloo with any information relative to same, including activities of our SUBCONTRACTORS and suppliers as necessary or when requested. M. Parity figures for companies located i Minority Parity = .08 (8%) are as follows: N. Affirmative Action -MN?? FH. (Na P.O. BOX 459 j CLAR.KSVILLE, IA 54619 Employment Goals: The definition of Affirmative Action Goals is as follows: "Goals may not be rigid and inflexible quotas which must be met, but must be targets, reasonably attainable by means of applying every good faith effort to make all aspects of the entire Affirmative Action Program work." For the year 201_, please submit percentage targets for employing minorities and women. If you already have reached your target for hiring minorities and women, please submit that percentage. `Goals for Minorities: S Goals for Women: 5' *Your affirmative action goals should be between 1% and 10% or more for minorities and 1% and 5% or more for women. Please be advised that the goals or targets are purely your estimation of how many women and minorities your company can reasonably expect to hire in 201 . Note, that none of the goals are rigid or inflexible. They are targets that your company calculates as reasonably attainable. This will help the City in its monitoring procedures as required by City of Waterloo Resolution No. 1984- 142(4). -5 - CONTRACTOR'S TOTAL WORK FORCE (WATERLOO) NAME AND ADDRESS JOB CATEGORY RACE SEX HOURLY WAGE 6Je.'e i 6%3( - '- - - . e I CSiIWon. -ket \N! /pit /A- S---- "ce,,.. e\--,SC vi,.0'N.- c9 C 3. e. d K �] O SGC C7 � 110.0 { ! ,- T- %7/I f(e Pe ---_06--- ,-) age A r VV /171 c 2/ Ph, IA- `w30f Ui.r." WL 12 $s:_.., tic, f e 4 e kms.--�. �L v'\ g/ Sh«Lot-, _ eyen., 1ci t--- oma. :P y INDICATE: DISABLED VETERAN: DV VIETNAM ERA VETERAN: W HANDICAPPED: H -6 - We hereby certify that we are in compliance with all City and Federal Affirmative Action Regulations and agree to accept all liability for failure to comply. Respectfully submitted, By: Company Executive Date By: Equal Employment Opportunity Officer 7-/3-- /2 Date City of Waterloo Affirmative Action Officer Approved Disapproved Reason: By: Date: MBE/WSINSE / PRE-BID CONTABECTBUINFORESS MATIONENTERPRI LFORM I Prime Contractor Name: Le/eq. . P C6✓is-(i.L C, Project: 9j ;S- Letting Date: /.3 `2 ' NO MBE/WBE SUBCONTRACTORS: If you are NOT using any MBE/WBE subcontractors to complete this project, sign below. Attach a brief explanation as to why subcontracting was not feasible with this project. If any MBE/WBE subcontractors will be used, please use the bottom portion of this form. Contractor Signature: /.% � Title: `y41 l ���� Date: /3 SUBCONTRACTRS APPLICABLE: You are required, in order for your bid to be considered responsive, to provide the information on this form showing ALL of your MBENVBE subcontractor contacts made for your bid submission. This information is subject to verification. Any questions should be directed to Contract Compliance Office 319-291-4429. You are required, in order for your bid to be considered responsive, to provide the information on this Form showing your MBENUBE Business Enterprise contacts made prior to your bid submission. This information is subject to verifications and confirmation. If you are unable to identify MBENVBE firms to perform portions of the work, please contact Louis Starks, Contract Compliance Officer, for assistance at (319) 291- 4429. In the event it is determined that the MBE/WBE Business Enterprise goals are not met, then before awarding the contract the City of Waterloo will make a determination as to whether or not the apparent successful low bidder made good faith efforts to meet the goals. TABLE OF INFORMATION SHOWING BIDDER'S PRE-BID MBEIWBE BUSINESS ENTERPRISE CONTACTS Quotes Received Quotation Used in Bid MBEIWBE Subcontractors Dates Contacted Yes/No Dates Contacted Yes/No Dollar Amount Proposed to be Subcontracted `-',loci 7—//--/7 NO (Form CCO-4) Rev. 06-20-02 MBE/WBE PARTICIPATION AECOM 60543369 CONTRACT NO.935 M-6 OF 6