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HomeMy WebLinkAboutMunicipal Pipe Tool Company, LLCBid Due: February 7, 2019 Bid Time: 1:00 pm Bid Enclosed: FY 2019 CIP PIPELINING PHASE IIIC, City No 962 City Clerk City of Waterloo 715 Mulberry Street Waterloo, Iowa 50703 MUNICIPAL PIPE TOOL COMPANY, LLC 515 5th Street Box 398 Hudson, Iowa 50643 Bid Due: February 7, 2019 Bid Time: 1:00 pm Bid Enclosed: FY 2019 CIP PIPELINING PHASE IIIC, City No 962 City Clerk City of Waterloo 715 Mulberry Street Waterloo, Iowa 50703 Honorable Mayor and City Council Waterloo, Iowa FORM OF BID OR PROPOSAL FY 2019 CIP PIPELINING PHASE IIIC CONTRACT NO. 962 CITY OF WATERLOO, IOWA f ttfln6cipai PAI e Tool Co LLC Gentlemen: 1. The undersigned, being a Corporation existing under the laws of the State of a Partnership consisting of the following partners: vv le-ate4 flAV1lk tz, faVvu75 , 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 FY 2019 CIP PIPELINING PHASE IIIC, CITY CONTRACT NO. 962, all in accordance with the above -listed documents and for the unit prices for work in place for the following items and quantities: FY 2019 CIP PIPELINING PHASE IIIC CITY OF WATERLOO, IOWA CITY CONTRACT NO. 962 Item Description Unit Estimated Quantities Unit Price Total Amount 1 8" Diameter CIP Pipe Lining LF 9,850.00 $ a 0, 50 $ )00 25 ^ 2 10" Diameter CIP Pipe Lining LF 698.00 $ D, cc, $ 15,i ;105_ 3 12" Diameter CIP Pipe Lining LF 846.00 $ 75 $ .2.,..110.50 4 15" Diameter CIP Pipe Lining LF 301.00 $ 1.43 ,. $ 12,q1-1-5.(76 5 Pipe Televising - 8" LF 19,700.00 $ 0. Sc $ g �g50 .- 6 Pipe Televising - 10" LF 1,396.00 $ O.SU $ (AS - 7 Pipe Televising - 12" LF 1,692.00 $ © Geo $ 31.4,- 8 Pipe Televising - 15" LF 602.00 $ 0 . 50 $ 30 I -- 9 Pipe Cleaning - 8" LF 9,850.00 $ 1.26 $ 12 , 31 2,,,0 10 Pipe Cleaning - 10" LF 698.00 $ ) , 25 $ g7 , SO 11 Pipe Cleaning - 12" LF 846.00 $ 1.2S $ 1057.50 FORM OF BID AECOM 60543369 CONTRACT NO. 962 Page BF -1 OF 3 FY 2019 CIP Pipelining Ph IIIC Item Description Umt Estimated quantities Unit Price Total Amount 12 Pipe Cleaning - 15" LF 301.00 $ I .1c $ C-5212:15 13 Type C Root Removal - 8"-10" LF 790.00 $ Ot , 50 $ 1115,00 14 Type C Root Removal - 12"-15" LF 98.00 $ _, $ ac14 ., oo 15 Lateral Reinstatement EA 282.00 $ 7. — $ 1 i 1 SO. - 16 3 -FT Lateral Grouting EA 282.00 $ ,x(11© $ 13,3D-0 — TOTAL BID & ?57'7 ?62 7E 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. 4. Security in the sum of l BorotJ% ur 131;=i Dollars ($ ) in the form of $ f'4- 30-v,. c4 , 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 the Bidder Status Form indicating Resident Bidder Certification ( L�), 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 MP 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. Nib N 6 Date 10. The bidder shall list the MBEMIBE 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). FORM OF BID CONTRACT NO. 962 Page BF -2 OF 3 AECOM 60543369 FY 2019 CIP Pipelining Ph IIIC 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. Municipal Pepe Tool Co LLC (Name of Bidder) (Date) BY: • V "5"" Title 00 Official Address: (Incl aIfilSiiiEipe Tool Co LLC 510 0th $t. PO Box 398 I4ucl$en3 IA 50643 - W=fig d-o5S313 I.R.S. No. FORM OF BID CONTRACT NO. 962 Page BF -3 OF 3 AECOM 60543369 FY 2019 CIP Pipelining Ph IIIC Bidder Status Form To be completed by all bidders Part A Please answer "Yes" or "No" for each of the following: [g,'Yes ❑ No ['Yes ❑ No 41/Yes ❑ No 14/es D No QNes ❑ 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). My company has an office to transact business in Iowa. My company's office in Iowa is suitable for more than receiving mail, telephone calls, and e-mail. My company has been conducting business in Iowa for at least 3 years prior to the first request for bids on this project. 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 Iowa during the past 3 years at the following addresses: LANBCOPAL PIWN SOU« Dates: / /. to / / Address* �� R REMOTE ff �l�'E D F tldSl'li NUJ Ii'Cl MR))A;,c G1PP6I ;tii PARTI City, State, Zip: 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 and truthful information may be a reason to reject my bid. ra kirn!iuCut� � 16�ar Tooll Co LLC Firm Name: Signature:') .GAi" i' ` Date: r C' 1 You must submit the completed form to the governmental body requesting bids per 875 Iowa Administrative Code Chapter 156. This form has been approved by the Iowa Labor Commissioner. 309-6001 (09-15) BSF- 1 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. ❑ Yes ❑ No My business is currently registered as a contractor with the Iowa Division of Labor. ❑ Yes ❑ No My business is a sole proprietorship and I am an Iowa resident for Iowa income tax purposes. ❑ Yes ❑ No 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. ❑ Yes ❑ No 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. ❑ Yes 0 No 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. ❑ Yes ❑ No My business is a limited liability partnership which has filed a statement of qualification in this state and the statement has not been canceled. ❑ Yes ❑ No 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 lowa and a statement of cancellation has not been filed. ❑ Yes ❑ No 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. ❑ Yes 9 No 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. ❑ Yes 0 No My business is a limited liability company whose certificate of organization is filed in Iowa and has not filed a statement of termination. ❑ Yes 9 No My business is a limited liability company whose certificate of organization is filed in a state other than lowa, has received a certificate of authority to transact business in Iowa and the certificate has not been revoked or canceled. 309-6001(09-16) BSF- 2 NON -COLLUSION AFFIDAVIT OF PRIME BIDDER State of I 0 W!k --tt )ss County of �lac�-- *' 3 f'OYN. lA..)OOgQ A\cw' , being first duly sworn, deposes and says that: 00 1. S He is (Owner, Partner,Officer, Representative, or Agent) , of; tigni mail IPiip Tool) C , 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, o rties in interest, including this affiant. (Signed) 1 V '�� ao COG Title Subscribed and sworn to before me this —1 day of Vie\l (v..a. - , 201a. geo-t;t--e AARA 1/1)-totid Title My commission expires APRIL DUFFNER Commission No.767326 My Co (na 5 9Aob xpirea 51 NON -COLLUSION AFFIDAVITS CONTRACT NO. 962 Page NCA -1 OF 2 AECOM 60543369 FY 2019 CIP Pipelining Ph IIIC Attachment 1 SRF Required Front -End Specifications (This form must be completed and signed by Prime Contractor and submitted with the bid.) U.S. Environmental Protection Agency Certification of Non -Segregated Facilities (Applicable to contracts, subcontracts, and agreements with applicants who are themselves performing Federally assisted construction contracts, exceeding $10,000 which are not exempt from the provisions of the Equal Opportunity clause.) By the submission of this bid, the bidder, offeror, applicant, or subcontractor certifies that he does not maintain or provide for his employees any segregated facilities at any of his establishments, and that he does not permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. He certifies further that he will not maintain or provide for his employees any segregated facilities at any of his establishments, and that he will not permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. The bidder, offeror, applicant, or subcontractor agrees that a breach of this certification is a violation of the Equal Opportunity clause in this contract. As used in this certification, the term "segregated facilities" means any waiting rooms, work areas, restrooms and washrooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking Tots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, creed, color, or national original, because of habit, local custom, or otherwise. He further agrees that (except where he has obtained identical certifications from proposed subcontractors for specific time periods) he will obtain identical certifications from proposed subcontractors prior to the award of subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Opportunity clause; that he will retain such certifications in his files; and that he will forward the following notice to such proposed subcontractors (except where the proposed subcontractors have submitted identical certifications for specific time periods): NOTICE TO PROSPECTIVE SUBCONTRACTORS OF REQUIREMENT FOR CERTIFICATIONS OF NON -SEGREGATED FACILITIES A Certification of Non -segregated Facilities, as required by the May 9, 1967, order (33 F.R. 7808, May 28, 1968) on Elimination of Segregated Facilities, by the Secretary of Labor, must be submitted prior to the award of a subcontract exceeding $10,000 which is not exempt from the provisions of the Equal Opportunity clause. The certification may be submitted either for each subcontract or for all subcontracts during a period (i.e., quarterly, semiannually, or annual (dkid.d a/s//9 Signature Date ($h a r,7-1 GOQ sr c A klL C D' Name and Title of Signer (Please Type) NOTE: The penalty for making false statements in offers is prescribed in 18 U.S.C. 1001. EPA -7 5720-4.2 May 2015 Attachment 2 SRF Required Front -End Specifications (This form must be completed and signed by the Prime Contractor and submitted with the bid.) Debarments and Suspensions Any bidder or equipment supplier whose firm or affiliate is listed in on the U.S. General Services Administration Excluded Parties List System web site at http://www.epls.gov/ will be prohibited from the bidding process. Anyone submitting a bid who is listed on this web site will be determined to be a non-responsive bidder in accordance with 40 CFR Part 31. United States Environmental Protection Agency Washington, DC 20460 Certification Regarding Debarment, Suspension, and Other Responsibility Matters The prospective participant certifies to the best of its knowledge and belief that it and the principals: (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; (b) Have not within a three year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission o f fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction: violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (c) Are not presently indicted for otherwise criminally or civilly charged by a government entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification; and (d) Have not within a three-year period preceding this application/proposal had one or more public transaction s (Federal, State, or local) terminated or cause or default. I understand that a false statement on this certification may be ground for rejection of this proposal or termination of the award. In addition, under 18 U SC Sec. 10 01, a false statement ma y result in a fine of up to $10,000 or imprisonment for up to 5 years, or both. C511) r6r--r) Gv a feh Typed Name & Title of Authorized Representative `S7/MuXD1 1/Jaa Signature of Authorized Representative Date ❑ I am unable to certify to the above statements. My explanation is attached. EPA Form 5700-49 (11-88) May 2015 Attachment 3 SRF Required Front -End Specifications (This form must be completed and signed by Prime Contractor and submitted with the bid.) Disadvantaged Business Enterprise (DBE) Solicitation It is EPA's policy that recipients of EPA financial assistance through the State Revolving Fund programs award a "fair share" of subagreements to small, minority and women -owned businesses, collectively know as Disadvantaged Business Enterprises (DBEs). Iowa's Fair Share goals are: Only work performed by certified DBEs can be counted toward the goals. In Iowa, DBEs must be certified through the Iowa Department of Transportation (IDOT). Information on certification requirements and a list of certified DBEs is on the IDOT website at http://www.iowadot.gov/contracts/contracts eeoaa.htm. Prime contractors' DBE requirements for SRF projects include: • Taking affirmative steps for DBE participation • Documenting the efforts and the proposed utilization of certified DBEs N SRF Applicant: Minority -Owned Business Enterprise (MBE) Goal Women -Owned Business Enterprise (WBE) Goal Construction 1.7% 2.2% Supplies 0.6% 5.6% Services 2.5% 11.3% Goods/Equipment 2.5% 10.4% Avera • a 1.8% 7.4% Only work performed by certified DBEs can be counted toward the goals. In Iowa, DBEs must be certified through the Iowa Department of Transportation (IDOT). Information on certification requirements and a list of certified DBEs is on the IDOT website at http://www.iowadot.gov/contracts/contracts eeoaa.htm. Prime contractors' DBE requirements for SRF projects include: • Taking affirmative steps for DBE participation • Documenting the efforts and the proposed utilization of certified DBEs N SRF Applicant: (j L-7, o i AmicYw v Bidder: 711 Ur) lel, ea lijo e 7-; - 7 / L' e ., G z c. Address: 5/5 5i -l? JI—ree/; //udJo-/-7 .7'1 50474/3 Contact Person: sh Ari -77 GVQfeh,61. t - Signature: 5hi v un0 Phone Number: ,/ 9_ q f/ 9,7,43— aD3— E-Mail Address: E-Mail Qf-,,mumu,, ja,,,e. C ,-7 l Check if Prime Contractor is: ❑ Minority -Owned ❑ Women -Owned May 2015 GOOD FAITH EFFORTS CHECKLIST Please complete the checklist to determine if you have complied with the requirement to make good faith efforts to ensure that certified DBEs have the opportunity to compete for procurements funded by EPA financial assistance funds. Bidders/offerers must make good faith efforts prior to submission of bids/proposals. 1. Did you ensure that DBEs are made aware of contracting opportunjties to the fullest extent practicable through outreach and recruitment activities? Yes ❑ No 2. Did you make information on forthcoming opportunities available to DBEs and arrange time frames for contracts and establish delivery schedules, where the requirements permit, in a way that encourages and facilitates participation by DBEs in the competitive proce ? This includes, whenever possible, posting solicitation for bids or proposals for a minimum of 0 alendar days before the bid or proposal closing date. ❑ Yes o 3. Did you consider in the contracting process whether firms competing for large contracts could subcontract with DBEs? This will include dividing total requirements, when economically feasible, into smaller tasks or quantities to permit maximum participatipn by DBEs in the competitive process. u,,1 Yes 0 No 4. Did you encourage contracting with a consortium of DBEs when a contract is too large for one of these firms to handle individually? trEl Yes ❑ No 5. Did you use the services of the Small Business Administration and the Minority Business Development Agency of the Department of Commerce to identify potential subcontractors? Yes ❑ No 6. List the potential DBE subcontractors that were contacted. Only list those that are certified through the Iowa Department of Transportation. Name How Contacted (e.g. letter, phone call, fax, e/ -mail) Response (e.g. did not respond, not interested, not competitive) e w i (( Se 1 C �ey('i (ZAA CW li o l/t, PROPOSED UTILIZATION OF DBE SUBCONTRACTORS Please include Attachments 4 and 5 to document the proposed utilization of certified DBE subcontractors. May 2015 Attachment 4 SRF Required Front -End Specifications (This form must be completed and signed by Prime and DBE Subcontractor for each subcontract and submitted with the bid.) OMB Control No: 2090-0030 Approved 8/13/2013 Approval Expires 8/31/2015 United States Environmental Protection Agency Disadvantaged Business Enterprise Program DBE Subcontractor Performance Form This form is intended to capture the DBE' subcontractor's2 description of work to be performed and the price of the work submitted to the prime contractor. An EPA Financial Assistance Agreement recipient must require its prime contractor to have its DBE subcontractors complete this form and include all completed forms in the prime contractor's bid or proposal package. Subcontractor Name . Project Name Bid/Proposal No. Assistance Agreement ID No. (if known) Point of Contact Address Telephone No. Email Address Prime Contractor Name 7/U71fe--/p ' &e To -a / ca.., t c. Issuing/Funding Entity Contract Item Number Description of Work Submitted to the Prime Contractor Involving Construction, Services, Equipment or Supplies Price of Work Submitted to the Prime Contractor DBE Certified by DOT SBA Meets/exceeds EPA certification standards? YES NO Unknown Other: 1A DBE is a Disadvantaged, Minority, or Woman Business Enterprise that has been certified by an entity from which EPA accepts certification as described in 40 CFR 33.204-33.205 or certified by EPA. EPA accepts certifications from entities that meet or exceed EPA certification standards as described in 40 CFR 33.202. 2Subcontractor is defined as a company, firm, Joint venture, or individual who enters into an agreement with a contractor to provide services pursuant to an EPA award of financial assistance. EPA Form 6100-3 (DBE Subcontractor Performance Form) — Page 1 May 2015 OMB Control No: 2090-0030 Approved 8/13/2013 Approval Expires 8/31/2015 United States Environmental Protection Agency Disadvantaged Business Enterprise Program DBE Subcontractor Performance Form certify under penalty of perjury that the forgoing statements are true and correct. Signing this form does not signify a commitment to utilize the subcontractors above. I am aware of that in the event of a replacement of a subcontractor, I will adhere to the replacement requirements set forth in 40 CFR Part 33 Section 33.302 (c). Prime Contractor Signature Print Name 94a,te-y) R)a o co2d,tn (Ja✓z/21e Title Date cp--( S-1/ Subcontractor Signature Print Name Title Date The public reporting and recordkeeping burden for this collection of information is estimated to average three (3) hours per response. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address. EPA Form 6100-3 (DBE Subcontractor Performance Form) — Page 2 May 2015 Attachment 5 SRF Required Front -End Specifications (This form must be completed and signed by Prime Contractor and submitted with the bid if utilizing DBE subcontractors.) OMB Control No: 2090-0030 Approved 8/13/2013 Approval Expires 8/31/2015 United States Environmental Protection Agency Disadvantaged Business Enterprise Program DBE Subcontractor Utilization Form This form is intended to capture the prime contractor's actual and/or Intended use of identified certified DBE1 subcontractors2 and the estimated dollar amount of each subcontract. An EPA Financial Assistance Agreement Recipient must require its prime contractors to complete this form and include it in the bid or proposal package. Prime contractors should also maintain a copy of this form on file. Prime Contractor Name ' 1-6.rz 1&yd-6 /i/e 77i -o / CD.j Ge_ Project Name - Bid/Proposal No. Assistance Agreement ID No. (if known) Point of Contact Address 5/5 .51 f¢-ree 4 mai .--1,1t 5D6, 4/3 Telephone No. 3/e?— 9. for— "7/R05 Email Address (TA a./—,47-7m/riur7,;0.;i9e. c Issuing/Funding Entity I have identified potential DBE certified subcontractors If yes, please complete the table below. If no, please explain: YES 1NO se / r pe-r vvt Subcontractor Name/Company Name Company Address/Phone/Email Estimated Dollar Amount Currently DBE Certified? v-6 Continue on back if needed 1A DBE is a Disadvantaged, Minority, or Woman Business Enterprise that has been certified by an entity from which EPA accepts certification as described in 40 CFR 33.204-33.205 or certified by EPA. EPA accepts certifications from entities that meet or exceed EPA certification standards as described in 40 CFR 33.202. 2Subcontractor Is defined as a company, firm, joint venture, or individual who enters into an agreement with a contractor to provide services pursuant to an EPA award of financial assistance. EPA Form 6100-4 (DBE Subcontractor Utilization Form) — Page 1 May 2015 OMB Control No: 2090-0030 Approved 8/13/2013 Approval Expires 8/31/2015 United States Environmental Protection Agency Disadvantaged Business Enterprise Program DBE Subcontractor Utilization Form certify under penalty of perjury that the forgoing statements are true and correct. Signing this form does not signify a commitment to utilize the subcontractors above. I am aware of that in the event of a replacement of a subcontractor, I will adhere to the replacement requirements set forth in 40 CFR Part 33 Section 33.302 (c). The public reporting and recordkeeping burden for this collection of information is estimated to average three (3) hours per response. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address. EPA Form 6100-4 (DBE Subcontractor Utilization Form) — Page 2 May 2015 Prime Contractor Signature Print Name 1110 I Wco SI) i- %owJYA k Title Date (1 a/ ✓'ti The public reporting and recordkeeping burden for this collection of information is estimated to average three (3) hours per response. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address. EPA Form 6100-4 (DBE Subcontractor Utilization Form) — Page 2 May 2015 Attachment 6 SRF Required Front -End Specifications (This form is not required for bidding. It is for the voluntary use of DBE Subcontractors.) OMB Control No: 2090-0030 Approved 8/13/2013 Approval Expires 8/31/2015 United States Environmental Protection Agency Disadvantaged Business Enterprise Program DBE Subcontractor Participation Form An EPA Financial Assistance Agreement Recipient must require its prime contractors to provide this form to its DBE subcontractors. This form gives a DBE1 subcontractor2 the opportunity to describe work received and/or report arty concerns regarding the EPA -funded project (e.g. in areas such as termination by prime contractor, late payments, etc.). The DBE subcontractor can, as an option, complete and submit this form to the EPA DBE Coordinator at any time during the project period of performance. Subcontractor Name 0 n67 Project Name Bid/Proposal No. Assistance Agreement ID No. (if known) Point of Contact Address Telephone No. Email Address Prime Contractor Name tri/ -1 4 A T°o/ Cp./ Lc c Issuing/Funding Entity Contract Item Number Description of Work Received from the Prime Contractor Involving Construction, Services, Equipment or Supplies Amount Received by Prime Contractor /J? y o 1A DBE is a Disadvantaged, Minority, or Woman Business Enterprise that has been certified by an entity from which EPA accepts certification as described in 40 CFR 33.204-33.205 or certified by EPA. EPA accepts certifications from entities that meet or exceed EPA certification standards as described in 40 CFR 33.202. 2Subcontractor is defined as a company, firm, joint venture, or individual who enters into an agreement with a contractor to provide services pursuant to an EPA award of financial assistance. EPA Form 6100-2 (DBE Subcontractor Participation Form) — Page 1 May 2015 OMB Control No: 2090-0030 Approved 8/13/2013 Approval Expires 8/31/2015 United States Environmental Protection Agency Disadvantaged Business Enterprise Program DBE Subcontractor Participation Form Please use the space below to report any concerns regarding the above EPA -funded project: Subcontractor Signature Print Name Title Date EPA FORM 6100-2 (DBE Subcontractor Participation Form) Return to: Regional Coordinator, Small Business Utilization, U.S. Environmental Protection Agency, Region 7, 11201 Renner Blvd., Lenexa, KS 66219 The public reporting and recordkeeping burden for this collection of information is estimated to average three (3) hours per response. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address. EPA Form 6100-2 (DBE Subcontractor Participation Form) — Page 2 May 2015 MBEIWBE BUSINESS ENTERPRISE PRE-BID CONTACT INFORMATION FORM Lgraici a. Pape Tool Co LLC 0 PP PI/Ktie 27-11 Prime Contractor Name: Project: 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 feasible with thisf project. If any MBE/WBE subcontractors will be used, please use the bottom portion of this form. V ► Contractor Signature:Cl/V+ [,'Ua Title: OC) Date: Q NI( 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 iI%N-b ,i (D6 6 / i H/,' O- e IAM v( `-1 7p; fel/l we,* is 5ddF. p a/ (Form CCO-4) Rev. 06-20-02 ITEMS OF POTENTIAL MBE/WBE AECOM 60543369 CONTRACT NO. 692 Page M-6 OF 6 FY 2019 CIP Pipelining Ph IIIC BID BOND KNOW ALL MEN BY THESE PRESENTS, that we, Municipal Pipe Tool Co., LLC as Principal, and Merchants Bonding Company (Mutual) 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 the 7th day of February , 2019 , for FY 2019 CIP Pipelining Phase IIIC. City Contract No. 962. City of ilaterlan,lnwa NOW, THEREFORE, (a) If said Bid shall be rejected, or in the altemate, (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 21st day of January , A,D. 2019 By Municipal Pipe Tool Co., LLC (Seal) Plias'pal Merchan,Bonding Comp By urety (Mutual) Att (Seal) -fact Dione R Young (Title) MERCHANT`S BONDING COMPANY,M POWER OF ATTORNEY Know All Persons By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., both being corporations of the State of Iowa (herein collectively called the "Companies") do hereby make, constitute and appoint, individually, Anne Crowner; Brian M Deimerly; Cameron M Burt; Cindy Bennett; Craig E Hansen; Dana Wiebers; Dione R Young; Jay D Freiermuth; Kathleen Brewer; Kevin J Knutson; Michelle R Gruis; Seth D Rooker; Shirley S Bartenhagen; Stacy Venn; Sydney Burnett; Tim McCulloh; Wendy A Casey their true and lawful Attorney(s)-in-Fact, to sign its name as surety(ies) and to execute, seal and acknowledge any and at bonds, undertakings, contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. This Power -of -Attorney is granted and is signed and sealed by facsimile under and by authority of the following By -Laws adopted by the Board of Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors of Merchants National Bonding, Inc., on October 16, 2015. "The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Attorneys -in -Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof." "The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually fixed." In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and aut hority 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 Companies have caused this instrument to be signed and sealed this 21st day of December , 2018 . STATE OF IOWA COUNTY OF DALLAS ss. On this this 21st day of December 2018 , before me appeared Larry Taylor, to me personally known, who being by me duly sworn did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the seals affixed to the foregoing instrument are the Corporate Seals of the Companies; and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. *. V:*. P 0 D74137 • .m. SOP 9At. i. � :• � -0- 0:—,• . E'. 1933 c: MERCHANTS BONDING COMPANY (MUTUAL) MERCHANT$ NATIONAL BONDING, INC. By President ALICIA K. GRAM Commission Number 767430 My Commission Expires April 1, 2020 Notary Public (Expiration of notary's commission does not invalidate this instrument) I, William Warner, Jr., Secretary of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., do hereby certify that the above and foregoing is a true and correct copy of the POWER-OF-ATTORNEY executed by said Companies, which is still in full force and effect and has not been amended or revoked. In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 21st POA 0018 (3/17) day of January 2019. Secretary