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18 2016 Rfl.T.:213:,1):5
25789 N Ave
Grundy Center, IA 50638
Oro R2090544
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FORM OF BID OR PROPOSAL
F.Y. 2017 REPAIRS TO 6T" ST., 191" ST, AND ANSBOROUGH AVE. BRIDGES
CONTRACT NO. 916
CITY OF WATERLOO, IOWA
Honorable Mayor and City Council
Waterloo, Iowa
Gentlemen:
1. The undersigned, being a Corporation existing under the laws of the State of Z'owA
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 AECOM 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 F.Y. 2017 REPAIRS TO 6T ST., 18T" ST., AND
ANSBOROUGH AVE. BRIDGES, Contract No. 916, all in accordance with the above -listed
documents and for the unit prices for work in place for the following items and quantities:
F.Y. 2014 REPAIRS TO 6T" ST., 18T" ST., AND ANSBOROUGH AVE. BRIDGES
CONTRACT NO. 916
Item'
r-0,'
.Nom
,r,„,
RefsNo.
+Descnptton
s. . .�_ .
< Unitt
�,aQty
i -Est
1UmBid P,nce=
ffotal Bid pace jp
1
2403-0100000
STRUCTURAL CONCRETE
(MISCELLANEOUS)
CY
6.6
$ G2,750. co
$ 16. /5o.00
2
2404-7775005
REINFORCING STEEL, EPDXY
COATED
LB
700.0
$ 3. vn
$ .2, 100. as
3
2413-1200100
NEOPRENE GLAND
INSTALLATION AND TESTING
LF
584.0
$ lvo. oo
$ 59, goo.r'u
4
2426-6772016
CONCRETE REPAIR
SF
22.0
$ 9s cv
$ 2,010,00
5
2426-6772020
PARTIAL DEPTH BRIDGE DECK
FINISH PATCH
SF
255.0
$ $S.oa
$ 0/,67C, ori
6
2518-6910000
SAFETY CLOSURE
EACH
32.0
7
2526-8285000
CONSTRUCTION SURVEY
LS
1.0
$ /Sso,00
$ f, Ss&uy
8
2528-8445110
TRAFFIC CONTROL
LS
1.0
$ taifoo. ay
$ l a, so o. o a
9
2533-4980005
MOBILIZATION
LS
1.0
$ 30‘ 04,0„.„0
$ 30, 000. az,
10
2599-9999005
FURNISH AND INSTALL LIGHT
POLE ANCHOR BOLT COVERS
EACH
40.0
$ 3S.oa
$ /, goo. on
11
2599-9999005
REMOVE AND REPLACE
EXPANSION JOINT CURB PLATE
EACH
6.0
$ 5,000. oo
$ 3o, oo-o. w
FORM OF BID
AECOM #60509356
CONTRACT Na 916
FB -1 of 3
6'"/18'"/Ansborough Bridge Repairs
12
2599-9999005
FURNISH AND INSTALL
EXPANSION JOINT
COVERPLATE
EACH
10.0
$ l yoa. cra
,
$ l 9, ornr. cR
13
2599-9999009
REMOVE EXISTING FLOOD
WALL CHANNEL
LF
31.3
$ /oo. w
$ 3, 1 to. cro
14
2599-9999009
FURNISH AND INSTALL FLOOD
WALL CHANNEL
LF
31.3
$ Q So. cry
$ ?Li 605;acs
15
2599-9999009
REMOVE EXISTING UTILITY BOX
FRAME
LF
19.0
$ 3$S aro
$ 7,31S.ao
16
2599-9999009
FURNISH AND INSTALL UTILITY
BOX FRAME AND COVERS
LF
19.0
$ 7So,cso
$ l°/,aSo, try
17
2599-9999010
FURNISH AND INSTALL
DEFLECTOR PLATE
LS
1.0
$ 9, Dao.o
$ 9,, 000. vo
TOTAL BID
$ a99 9 a 4. oo
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 clone 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.
4. Security in the sum of ft Dollars
($ ) in the form of Boo t3„oo is submitted herewith in
accordance with the INSTRUCTIONS TO BIDDERS.
5. Attached hereto is a Non -Collusion Affidavit of Prime Contractor.
6. Attached hereto is a Resident Bidder Certification ( X ) or Non -Resident Bidder Certification
( ). (Mark one.)
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. t Date S/SA.
10. The bidder shall list the MBE/WBE 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)
FORM OF BID CONTRACT NO. 916 FB -2 of 3
AECOM #60509356 6th/18'"/Ansborough Bridge Repairs
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.
Bent -Oka (ow,n,tcrt4141 LIC.
(Name of Bidder) (Date)
BY: % !> hot fine..wn= Title Reg:5
Official Address: (Including Zip Code):
2578? N. Xe.n.4.
6a40.woa+ Cana,c / TR SOl.7I
I.R.S. No. 1Y-307avB3
FORM OF BID CONTRACT NO. 916 FB -3 of 3
AECOM #60509356 6"1/18'"/Ansborough Bridge Repairs
RESIDENT BIDDER CERTIFICATION
CONTRACT NO: 41/4
PROJECT NAME: IZrvossRs re G M Sr. / /$ n 5t. / d Dm &a /lvt. &.voc. cs
DATE OF LETTING: 9/1944
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. Ifanother
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.
COMPANY NAME
Baat..O(uC 6wnsi-e.lSNL /LLL,
CORPORATE OFFICER Ga kg /Lsaz
TITLE PROs,
DATE
%/5"
RESIDENT BIDDER CONTRACT NO. 916 RB -2 of 3
AECOM #60509356 6th/18th/Ansborough Bridge Repairs
Prime Contractor Name:
MBE/WBE BUSINESS ENTERPRISE
PRE-BID CONTACT INFORMATION FORM
l oM4file. Cep r)./LcriNG, LLC.
Project: Cownz.sa Frv. 91l0
Letting Date: gl8ler.
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: gag s• Date: 0j$44
SUBCONTRACTORS APPLICABLE: You are required, in order for your bid to be considered responsive, to provide the information on this form
showing ALL of your MBE/WBE subcontractor contacts made for your bid submission. This information is subject to verification. Any questions
should be directed to Contract Compliance Office 319-291-4429.
You are required, in order for your bid to be considered responsive, to provide the information on this Form showing your MBE/WBE Business
Enterprise contacts made prior to your bid submission. This information is subject to verifications and confirmation.
If you are unable to identify MBE/WBE firms to perform portions of the work, please contact Louis Starks, Contract Compliance Officer, for
assistance at (319) 291-4429.
In the event it is determined that the MBE/WBE Business Enterprise goals are not met, then before awarding the contract the City of Waterloo will
make a determination as to whether or not the apparent successful low bidder made good faith efforts to meet the goals.
TABLE OF INFORMATION SHOWING BIDDER'S PRE-BID
MBE/WBE BUSINESS ENTERPRISE CONTACTS
Quotes Received Quotation used in bid
MBE/WBE
Subcontractors
Dates
Contacted
Yes/No
Dates
Contacted
Yes/No
Dollar Amount Proposed to
be Subcontracted
(Form CCO-4) Rev. 06-20-02
MBE/WBE PARTICIPATION
AECOM #60509356
&u at, A> SELF Pticreawr 2Terris OLPGs,fgr Fat M$K/&IBi Paten -cc pn.rna',
CONTRACT NO. 916
M-6 of 6
6th/18'"/Ansborough Bridge Repairs
INFORMATION NEEDED
FOR
IOWA CONSTRUCTION SALES TAX EXEMPTION CERTIFICATE
CONTRACTOR NAME:
ADDRESS:
(Check One) PRIME
FEDERAL ID#:
SUBCONTRACTOR
PROJECT NAME:
PROJECT CONTRACT NO.:
DESCRIPTION OF WORK:
❑ Brickwork
O Carpentry
❑ Concrete
O Drywall -Plaster -Insulation
O Electrical
O Excavation/Grading
O Flooring
O Heavy Construction
O Heating -Ventilating -Air Cond.
O Landscaping
O Painting
O Paving
O Plumbing
O Roofing -Siding -Sheet Metal
❑ Windows
0 Wrecking -Demolition
O Other (Please specify)
0
SALES TAX EXEMPTION CONTRACT NO. 916 STE-1 of 1
AECOM #60509366 6t /18'"/Ansborough Bridge Repairs
NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
State of lends
County of 6.eruP'1
)ss
it( kUwwuct , being first duly sworn, deposes and says that:
He is (Owner, Partner(61Q , Representative, or Agent) , of $0‘44.00.4t own2adas✓6, ccc.
, 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.
(Signed)
Subscribed and s orn to before me this t �? day of
�1)C , 2016.
617-j2,
CraVe207/7
My commission expires
1/ •
Title
BETTY HEEREN
COMMISSION NUMBER 76':
MY COMMISSION EXPIRES:
NON -COLLUSION AFFIDAVIT CONTRACT NO. 916
AECOM #60509356
NCA -1 of 2
6'" /18th/Ansborough Bridge Repairs
BID BOND
KNOW ALL MEN BY THESE PRESENTS, that we, Boulder Contracting, LLC
as Principal, and Nationwide Mutual 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 dated the18th day of
August 2016 , for F.Y. 2017 Repairs to 6th ST., 18th ST.,
and Ansborough Ave. Bridges
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 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 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 presents to be signed by their proper officers this 18th day of August , A.D.
2016.
(Seal)
(Seal)
Witness
itness
BID BOND
AECOM #60509356
Boulder Contracting, LLC
incipal
By
(Title)
Surety Nationwide Mutual Insurance Company
By
l�b
A ;ON y -in facttancy D. Baltutat
CONTRACT NO. 916 BB -1 of i
6`"11&`"/Ansborough Bridge Repairs
KNOW ALL MEN BY THESE PRESENTS THAT:
Nationwide Mutual Insurance Company, an Ohio corporation
Farmland Mutual Insurance Company, an Iowa corporation
Nationwide Agribusiness Insurance Company, an Iowa corporation
Power of Attorney
AMCO Insurance Company, an Iowa corporation
Allied Property and Casualty Insurance Company, an Iowa corporation
Depositors Insurance Company, an Iowa corporation
hereinafter referred to severally as the "Company" and collectively as the "Companies," each does hereby make, constitute and appoint:
GREG T. LAMAIR
PATRICK K DUFF
CHRISTOPHER R. SEIBERLING
MARK E. KEAIRNES
JEFFREY K. BAKER
JOSEPH IRV IN SCH MIT
NANCY D. BALTUTAT
JILL SIIAFFER
WEST DES MOINES IA
each In their individual capacity, its true and lawful attorney -In -fact, with full power and authority to sign, seal, and execute an its behalf any and all bonds and undertakings,
and other obligatory instruments of similar nature, in penalties not exceeding the sum of
THREE MILLION AND NO/100 DOLLARS S 3,000,000,00
and to bind the Company thereby, as fully and to the same extent as If such instruments were signed by the duly authorized officers of the Company; and all acts of said
Attorney pursuant to the authority given are hereby ratified and confirmed.
This power of attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the board of directors of the Company:
"RESOLVED, that the president, or any vice president be, and each hereby Is, authorized and empowered to appoint attorneys -in -fact of the Company, and to authorize
them to execute and deliver on behalf of the Company any and all bonds, forms, applications, memorandums, undertakings, reoognizances, transfers, contracts of
indemnity, policies, contracts guaranteeing the fidelity of persons holding positions of public or private trust, and other writings obligatory in nature that the business of
the Company may require; and to modify or revoke, with or without cause, any such appointmentor authority; provided, however, thatthe authority granted hereby shall
In no way limit the authority of other duly authorized agents to sign and countersign any of said documents on behalf of the Company."
"RESOLVED FURTHER, that such attorneys -In -fact shall have full power and authority to execute and deliver any and all such documents and to bind the Company
subject to the terms and limitations or the power 0f attorney issued to them, and t0 affix the seal of the Company thereto; provided, however, that said seal shall not be
necessary for the validity of any such documents.`
This power of attorney Is signed and sealed underand by the following bylaws duly adopted by the board of directors of the Company.
Execution of Instruments. Any vice president, any assistant secretary or any assistant treasurer shall have the power and authority to sign or attest all approved
documents, instruments, contracts, or other papers in connection with the operation of the business of the company in addition to the chairman of the board, the chief
executive officer, president, treasureror secretary; provided, however, the signature of any of them may be printed, engraved, or stamped on any approved document,
contract, Instrument, or other papers of the Company.
IN WITNESS WHEREOF, the Company has caused this instrument to be sealed and duly attested by the signature of Its officer the
13" day of February 2014 .
offY \' iirI�sm�rl
/. sEt1L- /« SEAL:«;
®�1t
m ilAn.44 'i01o""'
/,SEAL), ,HEAL .
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.M® . .
�``ww "'{y rsmw me` amuty Ane
;SAL)"
`( Notarial tical—lows
/;SEAL;,/ /SEAL`
Commission Number 152785
4 ' / + *` �I/ My Commission Expires Marc),, 24, 2117 Notary Public
+`\�s'�+ `,ta>.r� CERTIFICATE My Mach' 24, Commission
I, Robert W Horner III, Secretary of the Companies, do hereby certify that the foregoing Is a full, t ue and correct copy of the original power of attorney issued by the
Company; that the resolution included therein is a true and correct transcript from the minutes of the meetings of the boards of directors and the same has not been revoked
or amended in any manner; that said Terrance Williams was on the date of the execution of the foregoing power of attorney the duly elected officer of the Companies, and
the corporate seals and his signature as officer were duly affixed and subscribed to the said instrument by the authority of said board of directors; andthe foregoing power of
attorney is still In full force and effect.
Terrance Williams, President and Chief Operating Officer of Nationwide Agribusiness Insurance Company
and Farmland Mutual Insurance Company; and Vice President of Nationwide Mutual Insurance Company,
AMCO Insurance Company, Allied Property and Casualty Insurance Company, and Depositors Insurance
Company
ACKNOWLEDGMENT
STATE OF IOWA, COUNTY OF POLK: ss
On this 13" day of February 2014 before me came the above-named officer for the Companies aforesaid, to
me personally known to be the officer described in and who executed the preceding instrument, and he
acknowledged tho execution of the same, and being by me duly sworn, deposes and says, that he is the officer
of the Companies aforesaid, that the seals affixed hereto are the corporate seals of sald Companies, and the
said corporate seals and his signature were duly affixed and subscribed to said instrument by the authority and
direction of sald Companies.
IN WITNESS WHEREOF, I have hereunto subscribed my name as Secretary, and affixed the corporate seals of said Companies this 18th day
of August 2016
This Power of Attorney Expires 12/10/16
13DJ 1(0314) (NI
01779
G Y/ w '-V—
Secretary