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Home My WebLink AboutVisu-Sewer, Inc.n CITY 2A__ERK C__cA--1 G -V \N\ ERLC) a rl\5 MaiL_X6R,R\i s';l2EEl WkTERL(1).1 1 F1 soy 03 PIS ojECT DuL_E FRom 1 /01.c1 C_,‘P PPEL P- SSE \kiLi CATH CoLs12nci No.G62 THU\ZSUAI ��3��w� '�, opm vo0 Prr �I l SU- S cl)\l E R, 230 kV1 SS 13ET1(.E12_ bRNE PE_W WI 5 0-12_ P(1L2.) �qs-Z�4o ID 1.:KSC_LOSED S V—Sewer Inspectisu. Maintain. Rehabilitate. I Q P3(YID FORM OF BID OR PROPOSAL FY 2019 CIP PIPELINING PHASE IIIC CONTRACT NO. 962 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 1/A1Sco.s Si rJ a Partnership consisting of the fallowing partners: — having familiarized (himself) (themselves) (itself) with the existing conditions an 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 $ 20.35 $ 2.00,1441.50 2 10" Diameter CIP Pipe Lining LF 698.00 $ 25.65 $ 1 L0,501.70 3 12" Diameter CIP Pipe Lining LF 846.00 $ 22.s0 $ 24,3L4.80 4 15" Diameter CIP Pipe Lining LF 301.00 $ Sq. 00 $ 1'j,'1 sq. 00 5 Pipe Televising - 8" LF 19,700.00 $ , so $ q, 25 0.00 6 Pipe Televising - 10" LF 1,396.00 $ . 50 $ ioq $.00 7 Pipe Televising- 12" LF 1,692.00 $ .50 $ 84to•00 8 Pipe Televising - 15" LF 602.00 $ . 50 $ 301. 00 9 Pipe Cleaning - 8" LF 9,850.00 $ 2.00 $ / q, 100.00 10 Pipe Cleaning - 10" LF 698.00 $ 2.00 $ 11 3q i,,00 11 Pipe Cleaning - 12" LF 846.00 $ 2.00 $ 11 LA 2.00 FORM OF BID AECOM 60543369 CONTRACT NO. 962 Page BF -1 OF 3 FY 2019 CIP Pipelining Ph IIIC Item Description Unit Qutimatedantities Qu Unit Price Total Amount 12 Pipe Cleaning -15" LF 301.00 $ 2.00 $ L002.00 13 Type C Root Removal - 8"-10" LF 790.00 $ 2,00 $ t r 5 80.00 14 Type C Root Removal -12"-15" LF 98.00 $ 3 00 $ zG 4.00 15 Lateral Reinstatement EA 282.00 $ ,- 3.00 $ 21,150.00 16 3 -FT Lateral Grouting EA 282.00 $ 2.515.00 $ $013'10, 00 TOTAL BID & 39'1 558.00 2. It is understood that the quantities set forth are approximate only and subject to variation and that the unit bid price for the work done shall govem in the actual payment to Contractor. 3. In submitting this bid, the bidder understands that the right is reserved by the City of Waterloo, Iowa, to reject any or all bids. If written notice of the acceptance of this bid is mailed, telegraphed, or delivered to the undersigned within thirty (30) days after the opening thereof, or at any time thereafter before this bld is withdrawn, the undersigned agrees to execute and deliver an agreement in the prescribed form and furnish the required bond and certificate of the insurance within ten (10) days after the agreement is presented to him for signature, and start work within ten (10) days after "Notice to Proceed" is issued. 4. Security in the sum of i-t\IF _PP RC.F).st 0-2 Amou1-t atO Dollars($ 590 o$ f3 r ) in the form of am O t n a 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 ( ✓ ), or Non -Resident Bidder Certification ( ). (Mark one.) 7. The bidder is prepared to submit a financial and experience statement upon request. B. 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 MBEWBE 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 Ail Subcontractor(s). FORM OF BID CONTRACT NO. 902 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. \\‘`. sE WeXc 1f tbi! awardreserves of a contractright due to budgetaalternates, ry I m tati ns ........ delete line items, and/or to reduce quantities prior • �J•••.. , /��. • ooRFAIA r� WER, C. FEERUPA.` 11‘ 201 1 «KNaRne of Bidder) (Date) SEAL�� - BY: ..*IL 6/2* 1-- Title PR E S l0 E►JT • #7▪ ,;:n'•• ..... n3/4.4t. ALExW aOER- .r `' NS` fftclal Address. (Including Zip Code): W73o t\\4485S aFTIGFR DP. PF wwtAkceE, Wt Sad12_ I.R.S. No. 3a- t2t011tO FORM OF BID CONTRACT NO. 962 Page BF -3 OF 3 AECOM 60543369 FY 2019 CIP Pipelining Ph IIIC NON -COLLUSION AFFIDAVIT OF PRIME BIDDER State of OtSCUtlst )ss County of WWUV.„F SHIR ) DEATH M. RLE'. A mpER , being first duly sworn, deposes and says that: P si$Q. STT 1. He is (Owner, a ner, Icer, Representative, or Agent) , of V ISU- S EWE -2, IMC. 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 i interest, including this affiant. (Signed) li �� HEATH ra• taL YO41aDE2 Przawn" Subscribed and sworn to before me this /STH day of F Title Lt5W E.. SCHuTitle NOT 1412y IPLL u 3 Lt C My commission expires Ft- RQ.0 1412.'( 15, 2019 201a. NON -COLLUSION AFFIDAVITS CONTRACT NO. 962 Page NCA -1 OF 2 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: Ez Yes 0 No ❑ Yes ❑ No [x Yes 0 No [21Yes 0 No gi 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). 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: Dates: 12. / 1^1 / 2008 to PRIS F 1111/ Address: 10 lo S 1ST" STREET S W City, State, Zip: mn SoP,1. C;r 1% , .B S 4QL-___- 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. Firm Name: \1st- SE.WE12 C Signature: ,[ yf (/(<V /( KEITH m. F\ — WlJDE.R, PeEstoast Date: FE.IQRI v a { "l1 7 019 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 Prime Contractor Name: v IS U.- SF 1n\EP amL' . MBE/WBE BUSINESS ENTERPRISE PRE-BID CONTACT INFORMATION FORM Fytotq CAP PtPELn t t4a. Project: PHASF llt!' Letting Date: FEBRUWQ- "It 2019 NO MBE/WBE SUBCONTRACTORS: If you are NOT using any MBE/WBE subcontractors to complete this project, sign below. Attach a brief explanation as to why subcontracting was not feasib with this project. If a y MBE/WBE subcontractors will be used, please use the bottom portion of this form. / Contractor Signature: ( [7( _ / Title: PREStba1ST Date: FEB RA—LA12.` `1t 7 ycl ETt Kt rn. ALLKRQC)F.2_ 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 MBEJWBE Business Enterprise contacts made prior to your bid submission. This information is subject to verifications and confirmation. If you are unable to identify MBEJWBE 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 Nd itE.SPOI.SSF (Form CCO-4) Rev. 06-20-02 ITEMS OF POTENTIAL MBEJWBE AECOM 60543369 CONTRACT NO. 692 Page M-6 OF 6 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 annually). Sign ure Date KF ITH rYl. PtLEX,RN\OER, PRF SWEtJT 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 SRF -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. KF ITN Prt F..XF \K1 flEJ21 PRF S mF LC( Typed Name & Title of Authorized Representative FEPlcaanira� 'AI MIR Signature of Autho ed Representative Date ❑ 1 am unable to certify to the above statements. My explanation is attached. EPA Form 5700-49 (11-88) SRF -3 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 PROJECT INFORMATION 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% Average 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 PROJECT INFORMATION SRF Applicant: atTy 0,9 \i P TE.R. LOO , _ R Bidder: \4ISU..- SEbSE-R, -1.h1C. Address: W 22 tS-18S5 (3E.TKEIR DR. PEWRI-L E, 13T- 53012. Contact Person: Cu • HOFFART Signature: ,,,4, Phone Number: (2_62..) u9.Q S - -2.3140 E -Mail Address: \I\Su-1rveo NtSu-SeL3eR.cam Check if Prime Contractor is: ❑ Minority -Owned ❑ Women -Owned SRF -4 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 opportunities to the fullest extent practicable through outreach and recruitment activities? g 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 process? This includes, whenever possible, posting solicitation for bids or proposals for a minimum of 30 calendar days before the bid or proposal closing date. 12/ Yes ❑ No 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 participation by DBEs in the competitive process. E✓T Yes El 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? E? Yes 9 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? 0 Yes 9 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) !Joann RK Cot4STR Ic_TIot1 E-mAiL_ htD h10-1- RESpo-o DELc*c CONST RUCTIONS, T_t.1C. E.-rntaiL LEADER CONS1Ruc-nor.I Co. E- MeiL - ROCTETRUckING..4-Cot3STR.Co. kET E- rnAi L IJONNt E. EARR tcuc Es, TMc. C - mYat L TH`(LOR Crn. S7ktACT1on3:4.1C. C' rnfltL- PROPOSED UTILIZATION OF DBE SUBCONTRACTORS Please include Attachments 4 and 5 to document the proposed utilization of certified DBE subcontractors. SRF -5 May 2015 CONTRACT ADMINISTRATION PROVISIONS Several contract provisions are required to prevent unfair practices that adversely affect DBEs. These include: 1. Prime Contractor must pay its Subcontractor for satisfactory performance no more than 30 days from the Prime Contractor's receipt of payment from the SRF loan recipient. 2. Prime Contractor must notify the SRF loan recipient in writing prior to termination of a DBE subcontractor for convenience. 3. Prime Contractor must employ the six Good Faith Efforts to solicit a replacement subcontractor if a DBE subcontractor fails to complete work under a subcontract for any reason. SRF -6 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 Issuing/Funding Entity Contract Item Number Description of Work Submitted to he Prime Contractor Involving Construction, Services, Equipment or Supplies Price of Work Submitted to the Prime Contractor Not\E 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 SRF -7 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 I 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 11// � REATH VA. le -1 LExA i o s g i6' ti(A rAA- ----, Title Date PRESt0at3T FE139.1Az2.1/41 'ir 2bt9 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 SRF -8 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 V1SU-SEWZ-R,-nSC. Project Name F' 2otq CLIP PtPELtN ma PHASE-. MC. G TV oc 1N\tATERLoo,ZR Bid/Proposal No. Assistance Agreement ID No. (if known) Point of Contact Address 1/423o WA%55 16ETKER DR. PE NVAUS-EE, WI. 53012 Telephone No. Et Lot Log 5-2340 Email Address V►Su-tncoevtsu- SeaeP.com Issuing/Funding Entity I have identified potential DBE certified subcontractors If yes, please complete the table below. If no, please explain: YES J NO Sit CtTFITIONSS No Rz$POt.1-SF To ()UR Subcontractor Name/Company Name Company Address/Phone/Email Estimated Dollar Amount Currently DBE Certified? K\ (1))E.:. 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. Subcontractor 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 SRF -9 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 I 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 ab/b/OIL L'� REITH N. HLEXANbC2 Title Date PREStbEtJ l FassaucciR1 I, Zot9 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 SRF -10 May 2015 BID BOND KNOW ALL MEN BY THESE PRESENTS, that we, Visu-Sewer, Inc. 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 Bid Amount --- Dollars ($ 5% of bid amount ) 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 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 sald Bid, Then this obligation shall be void, otherwise the same shall rernain 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 sNO\ t rrrrr it, extension. �\‘‘� SEW We i, IN WITNESS WHEREOF, the Principal and the Surety, have hereunto set their hands andS••and such of them as are corporations, have caused their corporate seals to be hereto affixed andUhe e pre5RpoR4' 0 encs to be signed by their proper officers this 31st day of January , A.D. 201 1h . c _ _ TP Visu-Sewer, Inc, (Se,SEq[ r Prin I By 2C/., ON kE.I.TH rn. fALEXAk3OEi?, PIZEStOSLSTtttII" Merchants Bonding Company (Mutual) \ont`r1(g0atyr, �2 Surety 1 t4 � By Q'✓k-a�.� V l i Witness /AZ* Witness BID BOND CONTRACT NO. 962 AECOM 00543369 MERCHANTS BONDING COMPANY. 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, Debbra A Hinkes; Pamela M Hinman; Robert M Tortelli their true and lawful Attomey(s)-In-Fact, to sign its name as surety(ies) and to execute, seal and acknowledge any and all 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 Attomey-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 6th day of April , 2017 . •••• ••(IO Nqi z;r _Q_ o'.v So 2003 ;;0 o•. STATE OF IOWA COUNTY OF DALLAS ss. On this this 6th day of April 2017 , 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. MERCHANTS BONDING COMPANY (MUTUAL) MERCHANTS 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 ??l day oIL Jos 9 et 'Z: 'a' 1933 : C . 2003 �: :s'•. ti. POA 0018 (3/17) Secretary