HomeMy WebLinkAboutLodge Construction\Nov4&00.0
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LODGE
CON RUCIION, INC.
R113=4591 CIAIVS'I, IA 50619
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FORM OF BID OR PROPOSAL
F.Y. 2019 LEVEE TREE CLEARING CEDAR RIVER
CONTRACT NO. 968
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
a a Partnership consisting of the following partners:
having familiarized (himself) (themselves'"' the existing conditions on
the project area affecting the cost of the we , • 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 F.Y. 2019 LEVEE TREE CLEANING CEDAR RIVER, Contract No.
968, 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. 2019 LEVEE TREE CLEANING CEDAR RIVER
CONTRACT NO. 968
BID
ITEM
DESCRIPTION
UNIT
EST. QTY.
UNIT BID
PRICE
TOTAL BID PRICE
1
MOBILIZATION
LS
1.00
00
$ 1S) 000
00
S1,55000
2
CLEARING AND GRUBBING
ACRE
6.55'02.3o00
i
$/74 'so
3
SEEDING, FERTILIZING AND MULCHING
ACRE
6.55
io°
$02,300
$ j5 Q om,
4
TRAFFIC CONTROL
LS
1.00
65-0° —
I r0 0
TOTAL B
60
D $ ocnn 08, //5—
FORM OF BID
CONTRACT NO. 968 Page 1 of 3
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withdrawn, the undersigned agrees to execute and deliver an agreement in the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.
0
4. Security in the sum of 7°
Dollars ($ ) in the form of Boy. ,
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
Bidder Certification ( ). (Mark one.)
), or Non -Resident
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 MBENVBE 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.
FORM OF BID CONTRACT NO. 968 Page 2 of 3
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.
(NaYhe of Bidder)
C.
(Date)
P-021
BY: °`'� S tel Title 5c n (
Official Address: (Including Zip Code):
Po. .tea/ frc7
cAr /':sv 1`I�e �� S-06 /51
I.R.S. No. __7_7aa
FORM OF BID
CONTRACT NO. 968 Page 3 of 3
NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
State of
County of D%c 1J. K )
J okh Sew
)ss
He is
Ccku jam,,,,, i ,, , the Bidder that' '; — i : ted the attached Bid;
Owner Partner Office
, being first duly sworn, deposes and says that:
or Agent) , of /°'4e.
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, incl • ing this
affiant.
(Signed)
Subscribed and sworn to before me this a Pik
7(4 UJ , 201k
My commission expires 117,4444 1 Sj aaaO
ootet LINDAKSENN
ti 0 COMMISSION N0. 803307
e
.. n MY COMMISSION EXPIRES
day of
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 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.
EQUAL OPPORTUNITY CLAUSE PAGE 1 OF 2 PAGES
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, 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)
(Appropriate Official)
(Title)
//- 2 —/0
(Date)
EQUAL OPPORTUNITY CLAUSE PAGE 2 OF 2 PAGES
TITLE VI CIVIL RIGHTS
During the performance of this contract, the contractor (for itself), its assignees, and
successors in interest (hereinafter referred to as the "contractor") agrees as follows:
1. Compliance with Regulations: The contractor shall comply with the Regulations
relative to non-discrimination in Federally assisted programs of the DOT Title 49,
Code of Federal Regulations, Part 21, as they may be amended from time to
time, (hereinafter referred to as the Regulations), which are herein incorporated
by reference and made a part of this contract.
2. Nondiscrimination: The contractor, with regard to the work performed by it during
the contract, shall not discriminate on the grounds of race, color, national origin,
sex, age, or disability in the selection and retention of subcontractors, including
procurement of materials and leases of equipment. The contractor shall not
participate either directly or indirectly in the discrimination prohibited by section
21.5 of the Regulations, including employment practices when the contract
covers a program set forth in Appendix B of the Regulations.
3. Solicitations for Subcontracts, Including Procurement of Materials and
Equipment: In all solicitations either by competitive bidding or negotiation made
by the contractor for work to be performed under a subcontract, including
procurement of materials or leases of equipment, each potential subcontractor or
supplier shall be notified by the contractor of the contractor's obligations under
this contract and the Regulations relative to non-discrimination on the grounds of
race, color, national origin, sex, age, or disability.
4. Information and Reports: The contractor shall provide all information and reports
required by the Regulations or directives issued pursuant there to, and shall
allow access to its books, records, accounts, other sources of information, and its
facilities as may be determined by the Contracting Authority, the Iowa DOT, or
FHWA to be pertinent to ascertain compliance with such Regulations, orders and
instructions. Where any information required of a contractor is in the exclusive
possession of another who fails or refuses to furnish this information the
contractor shall so certify to the Contracting Authority, the Iowa DOT, or the
FHWA as appropriate, and shall set forth what efforts it has made to obtain the
information.
5. Sanctions for Noncompliance: In the event of the contractor's noncompliance
with the nondiscrimination provisions of this contract, the Contracting Authority,
the Iowa DOT, or the FHWA shall impose such contract sanctions as they may
determine to be appropriate, including, but not limited to:
a. Withholding of payments to the contractor under the contract until the
contractor complies, and/or
b. Cancellation, termination, or suspension of the contract, in whole or in
part.
6. Incorporation of Provisions: The contractor shall include the provisions of
paragraphs (1) through (6) in every subcontract, including procurement of
materials and leases of equipment, unless exempt by the Regulations, or
directives issued pursuant thereto. The contractor shall take such action with
respect to any subcontract or procurement as the Contracting Authority, the Iowa
DOT, or the FHWA may direct as a means of enforcing such provisions including
sanctions for non-compliance: Provided, however, that, in the event of a
contractor becomes involved in, or it threatened with, litigation with a
subcontractor or supplier as a result of such direction, the contractor may request
the Contracting Authority or the Iowa DOT to enter into such litigation to protect
the interests of the Contracting Authority or the Iowa DOT; and, in addition, the
contractor may request the United States to enter into such litigation to protect
the interest of the United States.
Bidder Status Form
To be completed by all bidders Part A
4 PI ase answer "Yes" or "No" for each of the following:
Yes ❑ No My company is authorized to transact business in Iowa.
(To help you determine if your company is authorized, please review the worksheet on the next page).
es D No My company has an office to transact business in Iowa.
es 0 No My company's office in Iowa is suitable for more than receiving mail, telephone calls, and e-mail.
Yes 0 No My company has been conducting business in Iowa for at least 3 years prior to the first request for
y�.,� bids on this project.
l Yes 0 No My company is not a subsidiary of another business entity or my company is a subsidiary of another
business entity that would qualify as a resident bidder in Iowa.
If you answered "Yes" for each question above, your company qualifies as a resident bidder. Please
complete Parts B and D of this form.
If you answered "No" to one or more questions above, your company is a nonresident bidder. Please
complete Parts C and D of this form.
To be completed by resident bidders Part B
My company has maintained offices in lowa during the past 3 years at the following addresses:
Dates: l / /X/ /Cie /( / 02€9r-
/ /1 Address: 56/ ///
s9 q
City, State, Zip. C/� %1& j �� .SDG "
Dates. / / to / / Address
City, State, Zip:
Dates: / / to / / Address.
You may attach additional sheet(s) if needed.. City, State, Zip.
To be completed by non-resident bidders Part C
1. Name of home state or foreign country reported to the Iowa Secretary of State:
2. Does your company's home state or foreign country offer preferences to resident bidders, resident labor
force preferences or any other type of preference to bidders or laborers? Yes 0 No
3. If you answered "Yes" to question 2, identify each preference offered by your company's home state or foreign country
and the appropriate legal citation.
You may attach additional sheet(s) if needed.
To be completed by all bidders Part D
I certify that the statements made on this document are true and complete to the best of my knowledge and I know that my
failure to provide accurate-te_and truthful information may be a reason to reject my bid.
Firm Name: Zo. °�5 t✓ Cc`s J 4 L
Signature:
Date: //—,2-9-79
You must submit the completed form to the governmental body requesting bids per 875 Iowa Administrative Code
Chapter 156. This fonn has been approved by the Iowa Labor Commissioner.
309-8001 (09-15)
Worksheet: Authorization to Transact Business
This worksheet may be used to help complete Part A of the Resident Bidder Status form. If at least one of the following
describes your business, you are authorized to transact business in Iowa.
'N' Yes 0 No
Yes 0 No
❑ Yes (No
Yes 0 No
❑ Yes mNo
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
My business is currently registered as a contractor with the Iowa Division of Labor,
My business is a sole proprietorship and I am an Iowa resident for Iowa income tax purposes.
My business is a general partnership or joint venture. More than 50 percent of the general
partners or joint venture parties are residents of Iowa for Iowa income tax purposes.
My business is an active corporation with the Iowa Secretary of State and has paid all fees
required by the Secretary of State, has filed its most recent biennial report, and has not filed
articles of dissolution,
My business Is a corporation whose articles of incorporation are filed in a state other than Iowa,
the corporation has received a certificate of authority from the Iowa secretary of state, has filed
its most recent biennial report with the secretary of state, and has neither received a certificate of
withdrawal from the secretary of state nor had its authority revoked.
My business is a limited liability partnership which has filed a statement of qualification in this
state and the statement has not been canceled.
My business is a limited liability partnership which has filed a statement of qualification in a
state other than Iowa, has filed a statement of foreign qualification in Iowa and a statement of
cancellation has not been filed.
My business is a limited partnership or limited liability limited partnership which has filed a
certificate of limited partnership in this state, and has not filed a statement of termination.
My business is a limited partnership or a limited liability limited partnership whose certificate of
limited partnership is filed in a state other than Iowa, the limited partnership or limited liability
limited partnership has received notification from the Iowa secretary of state that the application
for certificate of authority has been approved and no notice of cancellation has been filed by the
limited partnership or the limited liability limited partnership.
My business is a limited liability company whose certificate of organization is filed in Iowa and has
not filed a statement of termination.
My business is a limited liability company whose certificate of organization is filed in a state other
than Iowa, has received a certificate of authority to transact business in Iowa and the certificate
has not been revoked or canceled.
309-0001 (09-15)
Revised February 2003
CONTRACTOR'S OR SUBCONTRACTOR'S AFFIRMATIVE ACTION PROGRAM
Check ox that applies to party completing program:
( ) General Contractor
( ) Subcontractor
I. Section A to be completed by GENERAL CONTRACTORS only:
A.
Name of Company Ld cen,_/ ,„4,,., , ��
Address of Company /?O•%5d• Bo/ yZip SGAI l
Telephone Number (3/9 ) eS 37- 071 a'
Federal ID Number (if no Federal ID Number, Owner/President's Social
Security Number) r/7 -.)e ran o -
Name of Equal Employment Officer $-Fcue 104 -e-
Name
Name of Project t/ 02 -6i9 Leuee -free c (ee-r �y c
Project Contract Number nif
Estimated Construction Work Dates f -/elf / / 3 -/rd
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. The Owners and/or Principals of your company:
Ethnic
Name Address Position Sex Oriqin
,lae Gid%L %?O. Doiys9 o€ --K C.C. f41 WI
G t -i rsviIlef
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
-2 -
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. G-
E. 6 eye Coo r'c c will give training
(Name of Company)
and employment opportunities to local residents of Waterloo, Iowa, to
the greatest extent feasible.
III. AFFIRMATIVE ACTION
A. °�e �Chs�rL�iH A c recognizes that the
(Name of Company)
effective application of a policy of merit employment involves more than
just a policy statement, and
(Name of Company)
will, therefore, re-evaluate our Affirmative Action Program to ensure that
equal employment opportunities are available on the basis of individual
merit, and to actively encourage minorities, women and local residents
to seek employment with our company on this basis.
B. Gb'1f IV will undertake the
(Name of Company)
following six (6) steps to improve our Affirmative Action Program:
C.
1. Minority Recruitment and Employment;
2. Local Recruitment and Employment;
3. Disabled Veteran and Vietnam Era Veteran Recruitment and
Employment;
4. Handicapped Recruitment and Employment;
5. Female Recruitment and Employment; and
6. Training, Upgrading and Promotional Opportunities.
LU4c Cofs4n.Jz•n I will take
(Name of Company)
whatever steps are necessary to ensure that our total work force has
adequate minority, female, and local representation. We will utilize the
following methods in our recruitment attempts:
1. Local advertising media (newspapers, radio, TV);
2. Community organizations (churches, clubs, schools);
3. Public and private institutions in the area (UNI, Hawkeye
Community College);
4. Job Service of Iowa; and
5. Other.
-3 -
D. /o egic Cce--AteI/wr rt -e_ will seek qualified minority,
(Name of Company)
female, and local group applicants for all job categories 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.
F. Training, upgrading, promotion and transfer activities at all levels will be
monitored to ensure that full consideration has been given to qualified
minority, female, and local group employees.
G. G"() Cc its -10z-c/,c (mac will encourage other
(Name of Company)
companies with whom we are associated and/or do business, to do the
same and we will assist them in their efforts.
H. /0,f e_ 0, 1r5 4cs ;,Lhas taken the following
(Name of Company)
Affirmative Action to ensure that minority, female, local contractors
and/or suppliers were provided opportunities to negotiate and/or bid on
this project: (if none, write ',NONE")
1. /Cu-il5
G
2. Fel/ «a5
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")
1. Suits s
2.
J. w � L Conj. O 'f'Oo,- T c, will require approved
(Name of Company)
Affirmative Action Programs from all nonexempt contractors who
propose to work on this project and will take whatever steps are
necessary to ensure that non -minority contractors have adequate
representation of minority, female and local persons in their total work
force.
-4 -
K. In further accordance with rules and guidelines issued pursuant to
Executive Order 11246 as amended, we establish the goals for our
company, based on parity percentages supplied by the City, and we
realize these goals will be reviewed on an annual basis.
L �—°-• f �, C"villawt will keep records of
(Name of Company)
specific actions relative to recruitment, employment, 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 in Waterloo are as follows:
Minority Parity = .08 (8%)
La'v4se Ccyj4o�
(Name of Company)
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_7., 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:
Goals for Women: .
N.
/;-e-- Affirmative Action
*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 9. 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
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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: S-Av e Godj se -
Company Executive
/(�9' -/7
Date
By: .s-{GvG G°' _ca
Equal Employment
Opportunity Officer
/7-097-/7
Date
City of Waterloo Affirmative Action Officer
Approved
Disapproved Reason:
By:
Date:
7
Prime Contractor Name:
MBE/WBE BUSINESS ENTERPRISE
PRE-BID CONTACT INFORMATION FORM
t c. Cs...9iwc-fi un t c-- Project: 749
Letting Date:
NO MBEIWBE 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 feasib e with this project. If any MBE/WBE subcontractors will be used, please use the bottom
portion of this form.
Contractor Signature:
Title: Gi
Date: //027 /j
SUBCONT APPLICABLE: You are required, in order for your bid to be considered responsive, to provide the information on this form
showing ALL o 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 MBEIWBE 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 Rudy Jones, Contract Compliance Officer, for
assistance at (319) 291-4429.
In the event it is determined that the MBEIWBE 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 INFOR TION SHOWING BIDDER'S PRE-BID
MBEIWBE BUSINESS ENTERPRISE CONTACTS
Quotes Received Quotation used in bid
MBE/WBE
Subcontractors
Dates
Contacted
Yes/No
Dates
Contacted
Yes/No
Dollar Amount Proposed to 1
be Subcontracted
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(Forrn CCO-4) Rev. 06-20-02
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 the Bid Submitted ---
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 the29th day of November
, 2018 , for F.Y. 2019 Levee Tree Clearing Cedar River - Contract No 968 in the
_City of Waterlaa, Iowa
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 27th day of November , A.D. 2018
Lodge Construction, Inc.
Principal
North A !"ca Specialty Insurance Comparweal)
Attorney-in-fact Anne Crowner
/vim
(Seal)
(Title)
SWISS RE CORPORATE SOLUTIONS
NORTH AMERICAN SPECIALTY INSURANCE COMPANY
WASHINGTON INTERNATIONAL INSURANCE COMPANY
WESTPORT INSURANCE CORPORATION
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 Overland Park, Kansas 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 Overland
Park, Kansas, and Westport Insurance Corporation, organized under the laws of the State of Missouri, and having its principal office in the City of
Overland Park, Kansas each does hereby make, constitute and appoint:
JAY D. FREIERMUTH, CRAIG E. HANSEN, BRIAN M. DEIMERLY, SHIRLEY S. BARTENHAGEN, CINDY BENNETT, ANNE CROWNER,
TIM MCCULLOH„ STACY VENN, DIONE R. YOUNG, and WENDY ANN CASEY JOINTLY OR SEVERALLY
Its true and lawfid Attorney(s)-in-Fact, to make, 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: ONE HUNDRED TWENTY FIVE MILLION ($125,000,000.00) 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 North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held
on March 24, 2000 and Westport Insurance Corporation by written consent of its Executive Committee dated July 18, 2011.
"RESOLVED, that any two of the President, 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 the 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."
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Stteeven P. Anderson, Senior Vim President of Washington International Insurance Company
& Senior Vice President of North American Specialty Insurance Company
& Senior Vire President of Westport Insurance Corporation
By
Mike A. Ito, Senior Vice President of Washington International Insurance Company
& Senior Vice President of North American Specialty Insurance Company
& Scnlor Vim President of Westport insurance Corporation
IN WITNESS WHEREOF, North American Specialty Insurance Company, Washington International Insurance Company and Westport
Insurance Corporation have caused their official seals to be hereunto affixed, and these presents to be signed by their authorized officers this
this 3rd day of November , 20 17
State of Illinois
County of Cook
On this 3rd day of
North American Specialty Insurance Company
Washington International Insurance Company
Westport Insurance Corporation
Ss:
November , 20 17, 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 Senior Vice President of
Westport Insurance Corporation and Michael A. Ito Senior Vice President of Washington International Insurance Company and Senior Vice President
of North American Specialty Insurance Company and Senior Vice President of Westport Insurance Corporation, personally known to me, 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 h\,
M. KENNY �,_� \ �. ���`.,
Nm My Commission e tapirm nfIlltno
uis
12104/2021M. Kenny, Notary Public I
I, Jeffrey Goldberg , the duly elected Vice President and Assistant Secretary of North American Specialty Insurance Company, Washington
Intemational Insurance Company and Westport Insurance Corporation 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, Washington International Insurance Company and Westport Insurance
Corporation which is still in fill force and effect.
IN WITNESS WHEREOF, I have set my hand and affixed the seals of the Companies this27th day of November , 2018 .
Jeffrey Goldberg, Vice President & Assistant Secretary of Washington International Insurance Company &
Noah American Specialty Insurance Company & Vice President & Acsismni Secretary of Wesipon Insurance Corporation