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CITY OF WATERLOO, IOWA
WATERLOO LEISURE SERVICES COMMISSION
BID FORM
for
2017 TREE REMOVAL PROJECT
BIDDER: Vv (icon atdernn Te -et
COMPANY NAME
ADDRESS: c9 ka Short -j-r'tf
Of -PSCC , iia
PHONE: (5to3 ) 5Li7-44315
1. The undersigned, being a Corporation existing under the laws of the State of N/A ,
a Partnership consisting of the following partners: N/A
having been familiarized with the existing conditions on the project area affecting the
cost of the work, and with all the Contract Documents now on file in the offices of the
City Clerk, City Hall, Waterloo, Iowa, and the Waterloo Leisure Services Commission,
1101 Campbell Ave., Waterloo, Iowa, hereby proposes to furnish all supervision,
technical personnel, labor, materials, machinery, tools, equipment, and services,
including utility and transportation services required to complete the proposed 2017
TREE REMOVAL PROJECT, in accordance with the contract documents and for the bid
prices for the removal and disposal of 65 trees & associated stumps in city parks (Miller
Park, Liberty Park, & Ray Tiller Park) as described in the attached documents for the
following amount:
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BID P ICE
Dollars ($ ?91g90,6o )
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2. In submitting this bid, the Bidder understands that the City reserves the right to reject
any or all bids. If written notice of acceptance of this Bid is mailed or delivered to the
undersigned within thirty (30) days after Bid Opening, of 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this bid is withdrawn, the undersigned agrees to execute and deliver an agreement in the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 insurance within ten (10)
5. The Bidder is prepared to submit a financial and experience statement upon request.
6. The Prime Contractor and Subcontractor(s), which have performed an aggregate of
$10,000.00 in work for the City in the current calendar year, are prepared to submit an
AAP or Update and an EOC, within ten (10) days of notification that the bid submitted is
lowest and acceptable.
7. The Bidder has received the following Addendum or Addenda:
Addendum No.
Date: / /
/ /
/ /
8. The Bidder shall list the MBE/WBE subcontractors, amount of subcontracts and bid
items listed on the City of Waterloo Minority and /or Women Business Pre-bid Contract
Information Form submitted with this Bid Form. The apparent low bidder shall submit a
list of all other subcontractor(s) to be used on this project to the City of Waterloo by 5:00
p.m. the business day following the day bids on this project are due along with the Non-
collusion Affidavits of ALL Subcontractor(s).
The subcontractors listed on this proposal and/or submitted to the Contract Compliance
Officer cannot be changed except for the following reasons.
1. The City of Waterloo does not approve the subcontractors.
2. The subcontractors submit in writing that they cannot fulfill their subcontracts
9. The Bidder shall list all equipment available for this project:
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10. The Bidder has filled in all blanks on this proposal. Those blanks not applicable are
marked "none" or "NA".
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BID BOND
Bond No. 41384576
KNOW A 1.r. MEN BY )"HESE PRESENTS, that we, Jeff Wilson dba Wilson Custom Tree, 212 Short Ave, Cresco, IA
52136 as Principal, and Platte River Insurance Company, PO Box 5900, Madison, WI 53705-0900
as Surety are held and firmly bound unto the City of Waterloo, Iowa hereinafter called "OWNER". In the penal
sum of five percent (5%) of amount bid dollars
($ 5% of amount bid ) lawful money of the United States, for the payment of which sum will and truly be made,,
we bind ourselves. our hairs, 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 dated the 3rd day of October , 2017 , for 2017 Tree Removal Project
NOW, THEREFORE,
a) If said Rid shall he 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 pond 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 he void, otherwise the same 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 stilted.
By virtue of statutory authority, the full amount of this bid bond shall be l'orleited to the Owner in liquidation of
damages sustained in the event that the Principal falls to execute the contract and provide the bond as provided
in the specifications or by law.
The Surety, for value ree eived. 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 WHEREON, the Principal and the Surety. have hereunto set their hands and seals. and such of
thorn as arc corporations, have caused their corporate seals to be hereto affixed and these presents to be signed
by their proper officers this 3rd day of October , A.D. 20 17
Jeff Wilson dba Wilson Custom Tree
Principal
(Seal)
/n 1Ai v I—
ACKNOWLEDGMENT OF PRINCIPAL (Individual)
State of-�
County of i -c ' U.
On this ' day of &I -plea,) , in the year i1I , before me
personally comes ,Q&D--A
to me known and known to me to be the person who is described in and executed the foregoing instrument, and
acknowledges to me that he/she executed the same.
State of
April D. Buls
Commission Number 783136
MY COMM. EXP.03J/1./94
Notary Public
ACKNOWLEDGMENT OF PRINCIPAL (Partnership)
County of
}
On this day of , in the year , before me
personally come(s)
a member of the co -partnership of
to me known and known to me to be t person who is described in and executed the foregoing instrument, and
acknowledges to me that he/she executed the same as the act and deed of the said co -partnership.
Notary Public
ACKNOWLEDGMENT OF PRINCIPAL (Corporation/LLC)
State of
County of
On this day of , in the year , before me personally come(s)
, to me known, who being duly sworn, deposes and says that
he/she resides in the City of that he/she is the of the
, the corporation described in and
PLATTE RIVER INSURANCE COMPANY
POVVER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, That the PLATTE RIVER INSURANCE COMPANY, a corporation of the State of Nebraska, having its
principal offices in the City of Middleton, Wisconsin, does make, constitute and appoint
138457"6
-JACK ANDERSON; RONALD KAIHOI----•
its true and lawful'Attorney(s)-in-fact, to make, execute, seal and deliver: for and on its behalf, as surety, and as its act and deed, any and all bonds,
undertakings and contracts of suretyship, provided that no bond or undertaking or contract of suretyship executed under this authority shall exceed in
amount the sum of
ALL WRITTEN INSTRUMENTS IN AN AMOUN T NOT TO EXCEED: $20,000,000.00
This Power of Attorney is granted and is signed and sealed by facsimile under and; by the authority of the following Resolution adopted by the Board
of Directors of PLATTE RIVER INSURANCE COMPANY at a meeting duly called and held on the 8th day of January, 2002.
"RESOLVED, that the President, and Vice -President, the Secretary or Treasurer, acting individually or otherwise, be and they hereby are granted the
power and authorization to appoint by a Power of Attorney for the purposes only of executing and attesting bonds and undertakings and other writings
obligatory in the nature thereof, one or more vice-presidents, assistant secretaries and attorney(s)-in-fact, each appointee to have the powers and duties
usual to such offices to the business of the company; the signature of such officers and the seal of the Corporation maybe affixed to such power of
attorney of to any certificate relating thereto by facsimile, and any such power of trttorney or certificate bearing such facsimile signatures or facsimile
seal shall be valid and binding upon the Corporation in the future with respect to any bond or undertaking or other writing obligatory in the nature
thereof to which it is attached. Any such appointment may be revoked, for cause, or without cause, by any of said officers, at any time,"
In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and authority hereby given to the
Attorney -in -Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts
required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation
making paytnent of the final estimate to the Contractor and/or its assignee', shall not relieve this surety company of any of its obligations under its bond.
In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to the
Attorney -in -Fact cannot be -modified or revoked unless prior written personal notice of such intent has been given to the Commissioner — Department of
Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation.
IN WITNESS WHEREOF, the PLATTE RIVER INSURANCE COMPANY has caused these presents to be signed by its officer undersigned and
its corporate seal to be hereto affixed duly attested, this 27th day of July, 2015.
Attest:
Gary W. Stumper
President
Surety & Fidelity Operations
STATE OF WISCONSIN l
COUNTY OF DANE j S.S.:
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PLATTE RIVER TNSLJRANCE COMPANY
Stephen J. Sills
CEO & President
On the 27th day of July, 2015 before me personally came Stephen J. Sills, to me known, who being by me duly sworn, did depose and say: that he
resides in the County of New York, State of New York; that he is President of PLATTE RIVER INSURANCE COMPANY, the corporation described
herein and which executed the above instrument; that he knows the seal of the said corporation; that the seal affixed to said instrument is such corporate
seal; that it was so affixed by order of the Board of Directors of said corporation and that he signed his name thereto by like order.
STATE OF WISCONSIN 1
ss:
L`
c.
David J. Regele
Notary Public, Dane Co., WI
ACKNOWLEDGEMENT OF SURETY
STATE OF MINNESOTA
COUNTY OF CHIPPEWA
On this
3rd day of October , 2017 , before me, a Notary Public within and for said
County, personally appeared Ronald Kaihoi to me personally known, who being by me duly
sworn he/she did say that he/she is the attorney-in-fact of Platte River Insurance Company ,
the corporation named in the foregoing instrument, and the seal affixed to said instrument is the
corporation seal of said corporation, and sealed on behalf of said corporation by authority of its
Board of Directors and said Ronald Kaihoi acknowledged said instrument to be the free act
and deed of said corporation.
14/),44- IL- 1
NOTARY PUBLIC
My Commission Expires
REBECCA J. RISA
Notary Public -Minnesota
My Commission Expires Jan 31, 2020 t
AM/V vvI e
NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
State of . 'wnV )
County oa 1v NitA-) ) )
ict-n , being first duly sworn, deposes and says that:
1. He is (Owner), (Partner), (Officer), (Representative), or (Agent) of .J knio Cusforn
the Bidder that has submitted 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 interest, including this affiant.
(A7,Qn.o-cv
0wner
Title
NON -COLLUSION AFFIDAVIT OF SUBCONTRACTOR
State of N//-1 )
County of N/A ) )
N/A , being first duly sworn, deposes and says
that:
I. He is (Owner), (Partner), (Officer), (Representative), or (Agent) of N/A
hereinafter referred to as the "Subcontractor";
2. He is fully informed respecting the preparation and contents of the subcontractor's proposal
submitted by the subcontractor to N/A , contract
pertaining to the 2017 TREE REMOVAL PROJECT in Waterloo, Black Hawk County,
Iowa;
3. Such subcontractor's proposal is genuine and is not a collusive or sham proposal;
4. Neither the subcontractor 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 proposal in connection with such contract or to refrain from submitting a
proposal in connection with such contract, or has in any manner, directly or indirectly, sought
by unlawful agreement or connivance with any other bidder, firm or person to fix the price or
prices in said subcontractor's proposal, or to fix any overhead, profit or cost element of the
price of prices in said subcontractor's proposal, or to secure through collusion, conspiracy,
connivance or unlawful agreement any advantage against the City of Waterloo, Iowa, or any
person interested in the proposed Contract;
5. The price or prices quoted in the subcontractor's proposal 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 interest,
including this affiant.
N/A Ay/4
Signature Title
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 contractor, 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
£ 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
41, - A F�.........4;_,,.
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,
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.
Signed:
D writ✓
W
Appropriate Official
4 / .fib 1-1
Title
Date