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HomeMy WebLinkAboutLodge Construction, Inc.Lit :fft---t!i LODGE CONSTRUCTION, INC. P.Q. Box 459 1 50619 CieLK V\ilejec Ice) X /4 RE: d‘o 18 Ropdebi.,,,1 A -c-+: fr-L2, hctse, Me D c NS[R(FCTt(m\ .ty C l ec t V\JA,1-exlOv ) X{"� RE: tzoli, 61 0L- FORM OF BID OR PROPOSAL 2018 REMEDIAL ACTIONS PHASE IIIB CITY OF WATERLOO, IOWA CITY CONTRACT NO. 949 Honorable Mayor and City Council Waterloo, Iowa Gentlemen: ss -- 1. The undersigned, being a Corporation existing under the laws of the State of --N , a Partnership consisting of the following pa rs: having familiarized (himself) (themselves) 'tself 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 2018 REMEDIAL ACTIONS PHASE IIIB, CITY CONTRACT NO. 949, all in accordance with the above -listed documents and for the unit prices for work in place for the following items and quantities: 2018 REMEDIAL ACTIONS PHASE IIIB CITY OF WATERLOO, IOWA CITY CONTRACT NO. 949 (Bid item Nos. 2 and 3 not used to eliminate confusion between Bid Item numbers and Drawing numbers listed below.) Item Description Unit Estimated Quantiles Unit Price Total Amount 1 Pipe Televising - 8"-15" LF 9,501.00 $ $ ae72 /„`(7 `— eQ 4A DWG 4 Columbia Street - 12 IN Pipe Replacement 10-15 FT LF 248.00 $ j 0 0 $ / 00 0 0/ 3 4B DWG 4 Columbia Street - Restoration SY 925.75 $ %© '22- 09 $ S5,.5Its—.c.29- 4C 4C DWG 4 Columbia Street - Traffic Control LS 1.00 $ 5'-00 % $ 5-00 v% 5A DWG 5 Sumner Street - 8 IN Pipe Replacement 15-20 FT LF 137.00 $ E3% f 75 g$ 3 i ) i 7 5B DWG 5 Sumner Street - Restoration SY 878.90 $ 57 Q-= $ SO, 077 22 5C DWG 5 Sumner Street - Traffic Control LS 1.00 $ e0 0 $ 5-00 6A DWG 6 Valley Drive - 8 IN Pipe Replacement 0-10 FT LF 40.00 $ °� $ °� %j000 6B DWG 6 Valley Drive - Restoration SY 333.33 $ q76 °—` = $ 11)61,6 - 7A DWG 7 Upton Avenue - 8 IN Pipe Replacement 10-15 FT LF 20.00 of $ 35-0 �% $ 7 opo 7B DWG 7 Upton Avenue - Restoration SY 166.67 $ 3' % $ 4,./e‘ 22- 8A DWG 8 Carriage Hill Road - 8 IN Pipe Replacement 0-10 FT LF 122.00 $ 0 i �� $ 0 �f�2 �� 8B DWG 8 Carriage Hill Road - Restoration SY 506.67 $ 4e. $ 84 0 6 7 .A. ---t 8C DWG 8 Carriage Hill Road - Traffic ControlDWG LS 1.00 r $ 0 i ' 0 $ a v 5 cJ0 9A 9 Rep a emeCarriage n 0 10 Hill T Road - 8 IN Pipe LF 95.00 $ tgy °__ $ II t 8 7 °_ - FORM OF BID AECOM #60543369 CONTRACT NO. 949 BF -1 OF 4 Remedial Actions Ph IIIB Item Description Unit Estimated Quantiles Unit Price Total Amount 9B DWG 9 Carriage Hill Road - Restoration - Area 1 - Street SY 121.94 $ 117 °—r) $/t4,24‘ 98 9C ADWG 9 rea 2 Carriage Hill Road - Restoration SY 338.48 $ . ,27 % sq � 138' a/ - $ 5 -Do °� 9D DWG 9 Carriage Hill Road - Traffic Control LS 1.00 $ Sao % 10A DWG 10 Hickory Street - 8 IN Pipei Replacement 0-10 FT LF 20.00 $ �5 b ea $ pPO 10B DWG 10 Hickory Street - Restoration SY 166.67 O ° $ / - $ ,.d U©a Lo - 100 DWG 10 Hickory Street - Traffic Control LS 1.00 $ 'co °% $ 500 11 A DWG 11 Aladdin Street - 8 IN Pipe Replacement 0-10 FT LF 20.00 $ 5 ui 3 $ g'po i c?, 11B DWG 11 Aladdin Street - Restoration SY 166.67 $ 2,e2 is', $ 4 6a, .v --- v---110 110 DWG 11 Aladdin Street - Traffic Control LS 1.00 $Soo % $ Sd° i 12A DWG 12 Williston Road / Leavitt Street Alley - 8 IN Pipe Replacement 0-10 FT LF 20.00 $300 0� $ 000 of) G, 12B DWG 12 Williston Road / Leavitt Street Alley - Restoration SY 88.89 $ ? ° $ 8088 i� J 12C DWG 12 Williston Road / Leavitt Street Alley - Traffic Control LS 1.00 $ 5-00 i $ roe 13A DWG 13 Prospect Boulevard - 15 IN Pipe Replacement0-10 FT LF 40.00 $ p o 3a $/0(:)O ° 2) 13B DWG 13 Prospect Boulevard Restoration SY 333.33 $ a$- "� $ 211) 333 92, 2 13C DWG 13 Prospect Boulevard - Traffic Control LS 1.00 $ r00 o°. o $ 5` _ o 14A DWG 14 Prospect Boulevard - 10 IN Pipe Replacement 0-10 FT LF 20.00 $ S `� 37 $ Spp Mi 14B BO -15 FT 10 IN P pe Rep acement DWG 14 Prospect LF 20.00 $ 37. % $ 7)5-400 a� 140 DWG 14 Prospect Boulevard - Restoration SY 33333 /35- ke 22? .--✓ 14D DWG 14 Prospect Boulevard - Traffic Control LS 1.00 g po r-� ,c- p'' 15A DWG 15 Hammond Avenue / Lyon Avenue - 8 IN Pipe Replacement 0-10 FT LF 20.00 . � ado / 15B DWG 15 Hammond Avenue /Lyon Avenue - Restoration SY 166.67 37 ' - 4 /1j, 16A DWG 16 Ravenwood Circle - 8 IN Pipe Replacement 0-10 FT LF 20.00 $ 300 °� $ 6:9€20 0 - 16B DWG 16 Ravenwood Circle - 8 IN7� Restoration SY 166.67 $ 3 % $ �0�/6'J.:.,..::.::„,::><.::; TOTAL BID S a 01(8? 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 FORM OF BID AECOM 4160543369 CONTRACT NO. 949 BF -2 OF 4 Remedial Actions Ph IIIB 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 "' Dollars ($ ) in the form of gap. et- , 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 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. 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 EDO, 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 MBE/WBE subcontractor(s), amount of subcontracts and bid items on the City of Waterloo Minority and/or Women Business Pre-bid Contact Information Form submitted with this Form of Bid or Proposal. The apparent low Bidder shall submit a list of all other Subcontractor(s) to be used on this Project to the City of Waterloo by 5:00 p.m. the business day following the day Bids on this Project are due along with the Non -Collusion Affidavits of All Subcontractor(s). The Contractor shall submit information on subcontractors on "SUBCONTRACTOR REQUEST AND APPROVAL" Form to be provided by City prior to approval of contract. The subcontractors listed on this proposal and/or submitted to the Contract Compliance Officer cannot be changed except for the following reasons: 1) The City of Waterloo does not approve the subcontractors. 2) The subcontractors submit in writing that they cannot fulfill their subcontracts. 11. The bidder has filled in all blanks on this proposal. Those blanks not applicable are marked "none" or "NA". 12. The bidder has attached all applicable forms. FORM OF BID CONTRACT NO. 949 BF -3 OF 4 AECOM #60543369 Remedial Actions Ph 1118 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. 19 -e Cotes Qcar@%>+rl (Name of Bidder) BY: 3014‘-‘ Seosvr Title <_- Official Address: (Including Zip Code): c%� (Date) P o r Box 1 c i"t lit 17/t FITS- f�so6 19 % I.R.S. No. 7—v2 d 7 6 fcfc& FORM OF BID CONTRACT NO. 949 BF -4 OF 4 AECOM 460543369 Remedial Actions Ph IIIB NON -COLLUSION AFFIDAVIT OF PRIME BIDDER State of �, )ss County of �(3�-e�"'� 11� �c �OVIN sc-1�L✓l Ha is I Nr. being first duly sworn, deposes and says that: (Owner, Partner, Officer, epr@Seit•1fN ? r Agent) , of Lo rt enrs,r+-c r°'+ -t the Bidder that has submitted the attached Bid; 2. He is fully informed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid; 3. Such Bid is genuine and is not a collusive or sham Bid; 4. Neither the said Bidder nor any of its officers, partners, owners, agents, representatives, employees, or parties in interest, including this affiant, has in any way colluded, conspired, connived or agreed, directly or indirectly, with any other Bidder, firm or person to submit a collusive or sham Bid in connection with the Contract for which the attached Bid has been submitted or to refrain from bidding in connection with such Contract, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or conference with any other Bidder, firm or person to fix the price or prices in the attached Bid or of any other Bidder, or, to fix any overhead, profit or cost element of the bid price or the bid price of any other Bidder, or to secure through any collusion, conspiracy, connivance, or unlawful agreement any advantage against the City of Waterloo, Iowa, or any person interested in the Proposed Contract; and 5. The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the Bidder or any of its agents, representatives, owners, employees, or parties in interest, including tF» affiant. 2019 (Signed) Subscribed and sworn to before me this %iii day of o"i My commission expires > ztere/? a.DaO QtAL LINDAKSENN f A. -s COMMISSION NO. 803307 't ;"i MV COMMISSION EXPIRES Title NON -COLLUSION AFFIDAVITS City Contract No. 949 NCA -1 of 2 AECOM #60543369 Remedial Actions Ph 11113 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. 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, EQUAL OPPORTUNITY CLAUSE City Contract No. 949 Page EOC-1 of 2 AECOM 460543369 Remedial Actions Ph IIIB 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) (Date) EQUAL OPPORTUNITY CLAUSE City Contract No. 949 Page EOC-2 of 2 AECOM #60543369 Remedial Actions Ph IIIB Revised February 2003 CONTRACTOR'S OR SUBCONTRACTOR'S AFFIRMATIVE ACTION PROGRAM Check box that applies to party completing program: ( X ) General Contractor ( ) Subcontractor Section A to be completed by GENERAL CONTRACTORS only: A. Name of Company Lb 4e, 04.54w.o.il I /c Address of Company p-0- j30/ 73 GldrICsil ip» 5-4 Telephone Number (3) ) ,Z7d r7�7 Federal ID Number (if no Federal ID Number, Owner/President's Social Security Number) t7 -0364989- Name a ruffName of Equal Employment Officer S t e Lacs e Name of Project r ''/? RCmet't1.-J AC 4C1/1-5 ?b- dery >-i 977 Project Contract Number 9Vg Estimated Construction Work Dates )24 CoA- % % / Sf p� ,J 11 / Start Fi sh Section B to be completed by SUBCONTRACTORS only: B. Name of General or Prime Contractor Name of Subcontractor Subcontractor's Address Subcontractor's Telephone Number ( ) Subcontractor's Federal ID Number (if no Federal ID Number Owner/President's Social Security Number) Zip 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: -1 - Ethnic Name Address Position Sex Origin Cvc e _ Pia- Poe WI t wc., )41 VA' cics4le 5-120 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 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. E. t 06{ f Cc,.is 411S -1 -PL -q— "-r will give training ✓ (Name of Company) and employment opportunities to local residents of Waterloo, Iowa, to the greatest extent feasible. III. AFFIRMATIVE ACTION 1 A. Zolye C vt-5 recognizes that the (Name of Company) effective application of a policy of merit employment involves more than just a policy statement, and /odsem /-4.011,-e{v-- r (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. Z.o� will undertake the (Name of Company) following six (6) steps to improve our Affirmative Action Program: 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. C. /be"; r'i r tK i h ,' 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. D. /0,4 i c %L yah will seek qualified minority, female, (Name of Company) 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. LocLdip Ce -mss hoc -{'-i. AL— 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. -3 H. / o 1)c (t ,5'ka4L-- pLC� has 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") 2. As a result of the above efforts, we have involved minority, female, and local contractors and/or suppliers in thefollowingareas of subcontracting: (if none, write "NONE") 1. (Socket ;Inc 2. J. 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. 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. L vc1✓e, (o,.S c <-c 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%) Affirmative Action (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 , 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: 3 2 *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. 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). CONTRACTOR'S TOTAL WORK FORCE (WATERLOO) NAME AND ADDRESS JOB CATEGORY RACE SEX HOURLY WAGE s4eue I c -I3 ti 04:4.v < r �v /3° 3040-n Sc nil. 1::54;.4.-cd1 c4 M W y,ia 5W ic.1Se. /14-41144-1'frI-I" r 1fu as 13 (.406, .1 o), ,re- ^-4 -cr 114 1--v # ', 7 -"-pi A -6,c iv) IN ,/7 INDICATE: DISABLED VETERAN: DV VIETNAM ERA VETERAN: VV HANDICAPPED: H -5 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 -bole J deck Company Executiv Date By: ,c-je se t°'19 Equal Employment Opportunity Officer a �r Date City of Waterloo Affirmative Action Officer Approved Disapproved Reason: By: Date: -s Bidder Status Form To be completed by all bidders Part A 4PI ase answer 'Yes" or "No" for each of the following: f 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). Yes ❑ No My company has an office to transact business in Iowa. Yes ❑ 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 bids on this project. 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 My company has maintained offices in Iowa during the past 3 years at the following addresses: Dates: / / AYto /_/ ' / Address:_ -0.- /30( : cr City, State, Zip:. thres ‘f1Z,-. -_ c %.`-? Dates: 1 / to / / Address: City, State, Zip: Dates: ___......_./ / to _. ._/ / Address: You may attach additional sheet(s) if needed. City, State, Zip: Part C Part B To be completed by non-resident bidders 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 ®Yes ❑No force preferences or any other type of preference to bidders or laborers? 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: to4e_ Signature: Date: 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. 309-5001 (09-15) BSF-r 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 0 No 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. O 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. jZkYes ❑ 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. O Yes *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. O Yes No O Yes O Yes 14 No O Yes 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. 309-6091 (09-15) BSF-2 Prime Contractor Name: MBE/WBE BUSINESS ENTERPRISE PRE-BID CONTACT INFORMATION FORM Gadsr. Cc cJ4o+,. i nc.. Project: ? 9q Letting Date: NO MBE/WBE SUBCONTRACTORS: If you are NOT using any MBE/WBE subcontractors to complete this project, sign below. Attach a brief explanation as to why subcontracting was not feasible with this project. If any MBE/W BE subcontractors will be used, please use the bottom portion of this form. Contractor Signature: / Title: vk - 1 Date: cci6 l SUBCONTRACT S 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 Teti- /U,:sey/j —/y y�S a2-6— / 7 % i I#3 ©00 j PG Coif) Gos5i "/- / Yes d-6 - 1 / At j /-o-(r 40w bi cd,„/ \NI "ACG c2 / i /1)0 NO u &o4 -t. /V (Form CCO-4) Rev. 06-20-02 MBE/WBE PARTICIPATION AECOM #60543369 City Contract No. 949 Page M-7 of 7 Remedial Actions Ph 1116 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 fomes in the prime contractor's bid or proposal package. Subcontractor Name bci �J/ / e d f ✓G'ilf5<e,) Project Name } r� 1,0 Je?//n Pr Rern 1 it � ph,,,e_ 3 Bid/Proposal No. / Assistance Agreement ID No. (if known) Point of Contact "We .,fel g/9-7 a32 Address 2V•1g lac/ %Sry9.A. 44 kvave/Li 2'.9 se6._,--2 Telephone No. / n SI 351-0'1'1R Email Address r�d!-/nv„se.,���5a,1. cc 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 1/I3 » f? .5-13 li Cf 6!4 la ti 70 )3i V3 to 113 i( p 546(6 7 �, (3-7116 DBE Certified by h DOT SBA Meets/exceeds EPA certification standards? YES NO Unknown Other: 'A 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 Print Name ,flip Gy/,.0/_ Title Date Title 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 Subcontractor/acSignature Print Name ,flip Gy/,.0/_ " miged1/4„,--a/ Title Date 72 0/9 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 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 the 7th day of February , 2019 , for 2018 Remedial Actions Phase IIIB. City of Waterloo. Iowa - Contract No. 949 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 fumish 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 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 t�/l Lodge Construction, Inc. Seal) Principal Witness Cdy Bennett By North Americ Specialty Insure . Comparttreal) By Attorney -in- :ct/.ione R. Young (Title) OFFICIAL SEAL M. KENNY Notary Public; State of Illinois My Commission Expires 12104/2021 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 lawful 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." o =f SEAL Al1973 y.i.etio yaMPO..6t. ON I11t.... By Steven P. Anderson, Senior Vice President of Washington International Insurance Company Sr Senior Vice President of North American Specialty Insurance Company & Senior Vice 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 & Senior Vice 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 November , 20 17, before me, a Notary Public personally appeared Steven P. Anderson , Senior Vice President of ss: North American Specialty Insurance Company Washington International Insurance Company Westport Insurance Corporation 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. V� M. Kenny, Notary Public I, Jeffrey Goldberg , the duly elected Vice President and Assistant Secretary of North American Specialty Insurance Company, Washington International 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 full force and effect. IN WITNESS WHEREOF, I have set my hand and affixed the seals of the Companies this 21st day of January , 2019 Jeffrey Goldberg, Vice President & Assistant Secretary of Washington International Insurance Company & North American Specialty Insurance Company & Vice President & Assistant Secretary of Westport Insurance Corporation