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CITY OF WATERLOO, IOWA
WATERLOO LEISURE SERVICES COMMISSION
BID FORM
for
2018 FALL STUMP REMOVAL PROJECT
BIDDER: W Ikon Cuq,ivm I re e.
COMPANY NAME
ADDRESS: ala sbtvwtt'
(iris co , I 5213(0
PHONE: (50)3 )541 ---4a6S
1. The undersigned, being a Corporation existing under the laws of the State of W/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 2018
FALL STUMP REMOVAL PROJECT, in accordance with the contract documents and
for the lump sum price for the removal of the 813 stumps along City owned rights-of-way
and parks as listed in the attached documents for the following amount:
TOTAL BID PRICE:
(( riAALLi ,(-j-6tl v,,.aw Q) Oval btwnlGu,e- Dollars ($ /05)307.89)
U c toeri CvruC, 919/i&D
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this bid is withdrawn, the undersigned agrees to execute and deliver an agreement in the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)
days after the agreement is presented for signature, and start work within ten (10) days
after "Notice to Proceed" is issued.
51t )
3. Security in the sum of 4J�m 6fr (Mtn ($" submitted herewith in accordance
in the form of P -4I A, Srna,,
with NOTICE TO BIDDERS
4. Attached is a Non -Collusion Affidavit of Prime Contractor.
5. The Bidder is prepared to submit a financial and experience statement upon request.
BID FORM page 1 of 2
NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
State of ToWA )
County of iso ward ) )
pact ()k'v-n , being first duly sworn, deposes and says that:
1. He is (Owner), (Partner), (Officer), (Representative), or (Agent) of VPI , 1..u6lbm
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.
Title
su orthed'aj�' &worvvto-before. n ciao/ of_ t. k 2018.
SCratu.rei Tide
Greer 3f i -rJ is
.My conuvu�b.aw
NON -COLLUSION AFFIDAVIT OF SUBCONTRACTOR
State of /'./A )
County of A///a
Ai/A , being first duly sworn, deposes and says
that:
1. He is (Owner), (Partner), (Officer), (Representative), or (Agent) of AgA
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 2018 FALL STUMP 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 agre ment 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/i4 N/A
Signature Title
SubbcrGbed'and/ �worwto-before' pne'i1u�
N/A day of J1/7/4 , 2018.
N/4 (J/A
RAO -nature/ rate,
Hy co9tt on'ex3Gre4,__A///A
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
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
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.
EQUAL OPPORTUNITY CLAUSE PAGE 1 OF 2
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:
gli
Appropriate Official
Owner
Title
Date
EQUAL OPPORTUNITY CLAUSE PAGE 2 OF 2
Bond No.: 41393611
1311) BON!)
KNOW ALL \1FN 131' Il ll SF•: PRESENTS, that we, Jeff Wilson dba Wilson Custom Tree, 212 Short Avenue
Cresco, IA 52136 as Principal, and Platte River Insurance Company, P.O. Box 5900, Madison, WI 53705-0900
as Surety are held.uncl flunly bound unto the City of Waterloo, Iowa, hereinafter called "OWNER". In the penal
sunt Five Percent (5%) of Amount Bid
dollars
($5% of Amount Bid) lawful money of the United States. l'hr the payment Of which sum will and truly be made,
we bind ourselves, our hens, executors, administrators, and successors, jointly and several(}, firmly by these
presents. The condition of this obligation is such that whereas the Principal has submitted the accompanying
bid dated tiiel7thdtry of August , 20_18 , for 2018 Fall Stump Removal Project
NOW, THEREFOR E,
•
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 forth specified and
shrill fttrinsh a bond for his Willful performance of said contract, and fir the payment of'all parsons pertorminLt
labor or furnishing materials In connection therewith, and shall in all other respects peril -mut the agreement
created by the acceptance of said Hid,
Then this obligation shall be void, otherwise the same shall remain in torte and effect.; it being expressly
understood arid agreed that tate liability of the Surety for any and all claims hereunder shall, in no event, exceed
the penal amount of this obligation as herein staled,
By virtue of statutory authority, the full a nount 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 omitted
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 linty accept such Bid or
execute such contract; aix! said Surety does hereby waive notice of any such extension.
LN WITNESS WHEREOF, the Principal and the Surety, have hereunto set their hands and seals, and such of
them as are corporations, have coursed their corporate sails to be hereto affixed and these present: In tic signed
by their proper officers this 17th ,lay of August A.I. 20 18
Jeff Wilson dba Wilson Custom Tree (SC)
t'r 111Cf)r�1
Platte River Insurance Company
Surety
t.tv
Wlt,tess Rita J. rgen o Account Specialist Arts m v -in. ct Ronald Kaihoi
(Title) aw N-vr
(Seal)
BED BOND PAGE 1 OP 1
ACKNOWLEDGMENT OF PRINCIPAL (Individual)
State of itv,oaa
County of
On this
personally comes
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.
day of
, in the year 0/6 , before me
State of
County of
April D. Buls
Commission INurnber 783136
MY COMM EXPIJII/Q.
Notary Public
ACKNOWLEDGMENT OF PRINCIP L (Partnership)
}
On this
personally come(s)
a member of the co -partnership of
to me known and known to me to be the pers
day of
, in the year , before me
n who is described in and executed the foregoing instrument,
and acknowledges to me that he/she exec ed the same as the act and deed of the said co -partnership.
State of
County of
Notary Public
ACKNOWLEDGMENT OF PRINCIPACorporation/LLC)
On this day of
}
he/she resides in the City of
he year , before me personally come(s)
, to ne known, who being duly sworn, deposes and says that
that he/she is the of the
, the corporation described in and
which executed the foregoing instrument, a ti that he/she signed his/her name thereto by like order.
Notary Public
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PII ,AtI1TE RIVER INSURANCE COMPANY
POWER OJH' 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
--._. JACK ANDERSON; RONALD KAIHOI----------
its true and lawful Auorney(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 suin of
- --ALL WRITTEN INSTRUMENTS IN AN AMOUNT 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 PLAT"1'E RIVER INSURANCE COMPANY at a meeting duly called and.held on the 8th day of January, 2002 .
"RESOLVED, that the President; Executive Vice President, Vice President, Secretary or Treasurer, acting individually or otherwise, be and they hereby
arc granted the power.and:authorization to appoint by a Power of:Attorney for the purposes only of executing and attesting bonds and undertakiirgs, and
other writings obligatory in the nature thereof, one or more resident 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 this company; the signature of such officers and 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 valid and binding upon the Company, and any such power so executed and certified by facsimile signatures and facsimile seal
shall be valid and binding, upon the Company 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, forcause, 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 payment 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 3rd day of May, 2017.
Attest:
JoVin E. Rzepinski
Vice President, Treasurer & CFO
Suzanne M. Broadbent
Assistant Secretary
STATE OF WISCONSIN
COUNTY OF DANE
Q.
g.
i NSU iRAAto
P GORPORATe
ST
PLATTE RIVER INSURANCE COMPANY :.
Stephen J. Sills
CEO & President
On the 311:1 day of May, 2017 before me personally came Stephen J. Sills, to me knowli,'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 in 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
COUNTY OF DANE
S.S..
A\
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David J. Regele
Notary Public, Dane Co., WI
My Commission Is Permanent
I, the undersigned, duly elected to the office stated below, now the incumbent in PLATTE RIVER INSURANCE COMPANY, a Nebraska
Corporation, authorized to snake this certificate, DO HEREBY C +RTIF.Y that the foregoing attached Power of Attorney remains in full force and has
not been revoked; and furthermore, that the Resolution of the Board of Directors, set forth in the Power of Attorney is now in force.
Signed and sealed at the City of Middleton, State of Wisconsin this 1 7 th
day of August ,20"i 8
0-•
Antonio Celii
General Counsel, Vice President & Seecretary
THIS DOCUMENT IS NOT VALID UNLESS PRINTED ON GREEN SHADED BACKGROUND WITH A RED SERIAL NUMBER IN THE UPPER RIGHT HAND
CORNER. IF'YOU HAVE ANY QUESTIONS CONCERNING THE AUTHENTICITY OF THIS DOCUMENT CALL 800-475-4450. PRTOA (Rev. 10-2017)
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ACKNOWLEDGEMENT OF SURETY
STATE OF MINNESOTA
COUNTY OF CHIPPEWA
On this 17th day of August , 2018 , 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.
)0,,L0
NOTARY PUBLIC
My Commission Expires
//3i/vaoa3
LEANNE C. DUIS
Notary Public -Minnesota
<'' My Commission Expires Jan 31, 2023