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CITY OF WATERLOO
CITY CLERKS OFFICE
"MAY 90 2019 PH12: 9:4
4e7
1a4 W From St.
P.O. Box 369
Brooklyn, IA 52211
?71 D\b
0 2-1)\\ -\t ' CtiwAvr&ia,l
p�F W G��'� �O�rb�P���--S �1�'�`-c,k No 001,0
SVV,&
CITY OF WATERLOO
CITY CLERKS OFFICE
MAY 30 2019 PM12:50:1G
�5
BID BOND
KNOW ALL MEN BY THESE PRESENTS, that we, Minturn, Inc.
as Principal, and Merchants National Bonding, Inc.
as Surety are held and firmly bound unto the CITY OF WATERLOO , Iowa, hereinafter called
"OWNER." In the penal sum Five Percent of Amount Bid
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 30th day of May
, 2019, for City of Waterloo FY 2019 Jefferson and Commercial Streetscape
Improvements, City Contract No. 976
NOW, THEREFORE,
(a) If said Bid shall be rejected, or in the alternate,
(b) If said Bid shall be accepted and the Principal shall execute and deliver a contract in the form
specified and shall furnish a bond for his faithful performance of said contract, and for the payment of all
persons performing labor or furnishing materials in connection therewith, and shall in all other respects
perform the agreement created by the acceptance of said Bid,
Then this obligation shall be void, otherwise the same shall remain in force and effect; it being expressly
understood and agreed that the liability of the Surety for any and all claims hereunder shall, in no event,
exceed the penal amount of this obligation as herein stated.
By virtue of statutory authority, the full amount of this bid bond shall be forfeited to the Owner in
liquidation of damages sustained in the event that the Principal fails to execute the contract and provide
the bond as provided in the specifications or by law.
The Surety, for value received, hereby stipulates and agrees that the obligations of said Surety and its
bond shall be in no way impaired or affected by any extension of the time within which the Owner may
accept such Bid or execute such contract; and said Surety does hereby waive notice of any such
extension.
IN WITNESS WHEREOF, the Principal and the Surety, have hereunto set their hands and seals, and
such of them as are corporations, have caused their corporate seals to be hereto affixed and these pres-
ents to be signed by their proper officers this 30th day of May , A.D. 20 19
Witness
BID BOND
AECOM #60561525
Minturn, Inc.
By
(Seal) (NO5v)
(Title)
Merchants National Bonding, Inc. (Seal)
Surety
By
(1)Mq())11V—
Abigail R. Moh Attorney-in-fact
BB -1 OF 1 City of Waterloo FY 2019 Jefferson and
City Contract No. 976 Commercial Streetscape Improvements
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,
Abigail R Mohr; John R Fay; Kent M Rosenberg; Mat DeGroote; Matthew R Fay; Michael L McCoy
their true and lawful Attorney(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 MerchantsNational 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
.... q�
22 -O- G:O
Q
z
_' 2003 0;
STATE OF IOWA
COUNTY OF DALLAS ss.
On this this 13th day of March 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.
this instrument to be signed and sealed this 13th day of March , 2018 .
o\NG C042.
.
-0- 0;3
a' 1933 . c By
CY.
'et..1� .. •K.\.p
MERCHANTS BONDING COMPANY (MUTUAL)
MERCHANTS NATIONAL BONDING, INC.
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
POA 0018 (3/17)
and affixed the seal of the Companies on this
6'• 1933 Jc;
.y�� .•
pt10..
;hy..oe R4•%. ary>.
•S.' 2003 10
.04
30th day of May , 2019 .
Secretary
FORM OF BID OR PROPOSAL
CITY OF WATERLOO FY 2019 JEFFERSON AND
COMMERCIAL STREETSCAPE IMPROVEMENTS
CONTRACT NO. 976
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 .-%G'G? a
Partnership consisting of the following partners: /%%r/ fUi- �J12G
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 the City Engineer of the City of Waterloo now on file in the office of
the City Clerk, City Hall, Waterloo, Iowa, hereby proposes to furnish all supervision, technical
personnel, labor, materials, machinery, tools, appurtenances, equipment, and services, including
utility and transportation services required to construct and complete this CITY OF WATERLOO
FY 2019 JEFFERSON AND COMMERCIAL STREETSCAPE IMPROVEMENTS, City Contract
No. 976, all in accordance with the above -listed documents and for the unit prices for work in place
for the following items and quantities:
CITY OF WATERLOO FY 2019 JEFFERSON AND
COMMERCIAL STREETSCAPE IMPROVEMENTS
CITY CONTRACT NO. 976
ITEM
NO.
ITEM CODE
ITEM
UNIT
TOTAL
QTY
UNIT BID
PRICE
TOTAL BID
PRICE
1
SUDAS 2010-108-A-0
CLEARING AND GRUBBING
UNIT
85
$1Qaov
$ cOa�
2
SUDAS 2010-108-D-3
TOPSOIL, OFF-SITE
CY
106
$ (Q p'
$ (./ 360.00Q
3
SUDAS 2010-108-E-0
EXCAVATION, CLASS 10
CY
625
$ 0
$ 3 1 25p:
4
SUDAS 2010-108-1-0
SUBBASE, MODIFIED
SY
1626
$b'.O-
$13.00/T.'-
5
SUDAS 5020-108-H-0
FIRE HYDRANT ADJUSTMENT
EACH
1
oe
SVC/4ro
u
$ /, o00
6
SUDAS 6010-108-F-0
INTAKE ADJUSTMENT, MAJOR
EACH
1
$ Cf. O.-
t
$ It 040,
7
IA -DOT 2401-6745910
REMOVAL OF SIGN
EACH
17
$ 900-
$ (orb i
8
SUDAS 7010-108-E-0
CURB AND GUTTER, 30 IN. (WIDTH), 9
IN. (THICKNESS)
LF
82
$(405:" .0
$'
5. .
9
SUDAS 7010-108-E-0
CURB AND GUTTER, 30 IN. (WIDTH), 12
IN. (THICKNESS)
LF
160
nn
$ 7t/.
$
11,2i00-02-
10
SUDAS 7030-108-A-0
REMOVAL OF SHARED USE PATH
SY
113
$9.0.07
$ 22 �Od�
11
SUDAS 7030-108-A-0
REMOVAL OF SIDEWALK
SY
34
$Z0 _4-f-
$ (D J 6 o
12
SUDAS 7030-108-A-0
REMOVAL OF DRIVEWAY
SY
16
$20, -
og.
$ 320 .---
—13
13
SUDAS 7030-108-C-0
SHARED USE PATH, PCC, 6 IN.
SY
569
$(p07
$3'-f i yp,L°
14
SUDAS 7030-108-D-0
SPECIAL SUBGRADE PREPARATION
FOR SHARED USE PATH
SY
1626
$
3.o �
$ fig'
Lig
15
SUDAS 7030-108-E-0
SIDEWALK, PCC, 4 IN.
SY
15
$70,.
$ 1.0 50.(2i-
0.di16
16
SUDAS 7030-108-E-0
SIDEWALK, PCC, 6 IN.
SY
72
$ 7.3.
$ 5zS (a-
17
SUDAS 7030-108-E-0
SIDEWALK, COLORED PCC, 6 IN.
SY
629
$ 6 5 "-
$ 1f 0, rg S ,aJ
FORM OF BID
AECOM #60561525
FB -1 of 4
City Contract No. 976
City of Waterloo FY 2019 Jefferson and
Commercial Streetscape Improvements
ITEM
NO.
ITEM CODE
ITEM
UNIT
TOTAL
QTY.
UNIT BID
PRICE
TOTAL BID
PRICE
18
SUDAS 7030-108-F-2
gASEK K SIDEWALK WITH CONCRETE
SY
264
$ (0 °i
•
$ [.{9 g $ �,
19
SUDAS 7030-108-G-0
DETECTABLE WARNING, CAST IRON
SF
204
C�
$S.Q�-
$ ?0. 00
$9 1100 .Q.
$ -2 (o i
20
SUDAS 7040-108-1-0
CURB AND GUTTER REMOVAL
LF
242
21
IA -DOT 2523-6765009
REMOVE LIGHT POLE AND LUMINAIRE
REMOVE AND REINSTALL LIGHT POLE
AND LUMINAIRE
EACH
EACH
3
1
$ 450.9a
9%
$2 000-
$ l,3 5a
$ 00
ei • 000.
22
IA -DOT 2523$765009
23
IA -DOT 2523-0000100
LIGHTING POLES, TYPE 1
EACH
17
$3225:-1$
,a
54( X25•
24
IA -DOT 2523-0000100
LIGHTING POLES, TYPE 2
EACH
22
$ 111-50.~
o0
$1tDy SDO •'
25
IA -DOT 2523-0000200
ELECTRICAL CIRCUITS
LF
4398
$ (' f .257
,
$ (,2 • G11.60
26
IA -DOT 2523-0000310
HANDHOLES AND JUNCTION BOXES
EACH
2
$ Soo. v
$1,(000.0
27
IA -DOT 2523-0000400
CONTROL CABINET
EACH
1
$ '.i'
$ 1-• Soo_ s
28
IA-DOT2524-9325001
TYPE "A" SIGNS, SHEET ALUMINUM
SF
103.2
$ 22-oJ
$ 2_2¥0. Y0
29
IA -DOT 2524-9276010
PERFORATED SQUARE STEEL TUBE
POSTS
LF
176
$ G
$ iy ormo
30
IA -DOT 2524-9276021
PERFORATED SQUARE STEEL TUBE
POST ANCHOR: BREAK -AWAY SOIL
INSTALLATION
EACH
12
$ 3 5.9-9-
,�,p
$ (1.1,0.0—
31
IA -DOT 2524-9276024
PERFORATED SQUARE STEEL TUBE
POST ANCHOR, BREAK -AWAY CONC.
INSTALLATION
EACH
7
o0
$ go.-
$ 5(0o. QP --
32
PLAN
TRANSFORMER PAD
EACH
1
$(.0,00011.$G
opo .4212-
33
SUDAS 7080-108-G-0
PCC EDGE RESTRAINT, 12 IN. WIDE X
9 IN. HIGH
LF
326
coo
$ L.+ 3.r'
$'c.'r 01180
34
SUDAS 8030-108-A-0
TEMPORARY TRAFFIC CONTROL
LS
1
e.
$(,.000
$ G .000.—
000.-
35
SUDAS 9020-108-A-0
SOD
SQ
57
v.
$ 1
$ 1, (25 .'
36
SUDAS 9030-108-B-0
PLANTS WITH WARRANTY, TYPE 2,
PRINCETON SENTRY GINKGO
EACH
13
$
(o�S,
$ c
a 3-4'Gj•( .
37
SUDAS 9030-108-B-0
PLANTS WITH WARRANTY, TYPE 1,
COMMON HACKBERRY
EACH
EACH
14
3
$oe
�J 3S •
$52.6'.$
0
$ 9 �0 ,�
1,5 +51 `e
38
SUDAS 9030-108-B-0
SWAMP WHITOPLANTS WITH WA KRANTY, TYPE 1,
39
SUDAS 9030-108-B-0
PLANTS WITH WARRANTY, TYPE 1,
AUTUMN BLAZE MAPLE
EACH
5
$ oo
5025
pa
$‘2&.25 ,
40
PLAN
POROUS PAVE
SF
650
$2p da
$ oo =Q
}
41
SUDAS 9040-108-F-1
WATTLE, STRAW, 9 IN.
LF
560
$ 3.0.$
�
1680 --
42
SUDAS 9040-108-F-2
WATTLE, REMOVAL
LF
560
$1 ,25'"
$ '/00.'f2-*
43
SUDAS 9040-108-T-1
INLET PROTECTION DEVICE, OPEN-
THROAT CURB INTAKE SEDIMENT
FILTER
EACH
4
•
$ I'jQ/
'e
$ 5(00
44
SUDAS 9040-108-T-1
INLET PROTECTION DEVICE, GRATE
INTAKE SEDIMENT FILTER BAG,.
EACH
2
$$
3SO. CO
45
SUDAS 9040-108-T-2
INLET PROTECTION DEVICEop
,
MAINTENANCE
EACH
24
$ l
`J6•
$ (► 20 O
46
PLAN
LIMESTONE BLOCK
EACH
2
$(p,61°°r
_
$ (2,000--
47
SUDAS 11,020-108-A
MOBILIZATION
LS
1
$ Loi.lOD.
$ 4 .100 .S
TOTAL BID AMOUNT
$ (Q 19 2 0
FORM OF BID
AECOM #60561525
FB -2 of 4 City of Waterloo FY 2019 Jefferson and
City Contract No. 976 Commercial Streetscape Improvements
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
ri v c, \sick
Dollars ($ 9 n ) in the form of
RM. Qyvr•eL , 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 Bidders Status Form.
7. The bidder is prepared to submit a financial and experience statement upon request.
8. The Prime Contractor and Subcontractor(s), which have performed an aggregate of $10,000.00 in
work for the City in the current calendar year, are prepared to submit an AAP or Update and an
EOC, within ten (10) days of notification that the bid submitted is lowest and acceptable.
9. The bidder has received the following Addendum or Addenda:
Addendum No. Date
10. The bidder shall list the 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".
FORM OF BID
AECOM #60561525
FB -3 of 4 City of Waterloo FY 2019 Jefferson and
City Contract No. 976 Commercial Streetscape Improvements
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.
BY:
iniYl ktn n a1 ric
(Name of Bidder)
So, ZO m
Title (,e5\ Atfl
Official Address: (Including Zip Code):
Nil \N. -AF i Pb box9-io9
bY100 -1 n ,Tib S2Z
X�j13-,\ —�
I.R.S. No. `/ � 65W
FORM OF BID
AECOM #60561525
FB -4 of 4 City of Waterloo FY 2019 Jefferson and
City Contract No. 976 Commercial Streetscape Improvements
State of
NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
County of
1/0.ec\vii
CA i4Ann 61 • 14paaS
)ss
, being first duly sworn, deposes and says that:
1. He is Own , Partner, Officer, Representative, or Agent) , of ► l 4 ((r jTF t 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, or p _ ies in interest, inclu; g this affiant.
(Signed)
Subscribed and sworn to before me this
My commission expires
Title
3/7k -N day of i
L6
2
Title
Ott � Zd zZ ��►� merle �
itmNDY j RHOADS
2."*. Commission Nu�T���'er794952
•
' My Commission Expires
March 08, 2022
NON -COLLUSION AFFIDAVITS
AECOM #60561525
NCA -1 of 2
City of waterloo FY 2019 Jefferson and
City Contract Nol. 976 Commercial Streetscape Improvements
Bidder Status Form
To be completed by all bidders
Part A
Please answer "Yes" or "No" for each of the following:
a Yes LI No
Yes ❑ No
® Yes ❑ No
Yes ❑ No
g 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:
Vv ls
Dates: 01 / d \ / to ___ Address- i `"v`. ;Vivi* ¶ t '
Dates:
,�
r1 City, State, Zip: ::A1)-0 H 11 tt TA 5 i1l
TLO\t
d2 / 2'I ° to it / I ( / W/�1�Address- 01 `0f(4 rU/vo .
City, State, Zip: 2, 1IA) K/h t D c527
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 111 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:
Signature:
altvOuvo 1T -AL
Date: Ylr"_ i 51),2m, LU 9
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.
a Yes ❑ No
❑ Yes No
❑ Yes 641 No
51 Yes ❑ No
❑ Yes El 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.
My business is a general partnership or joint venture. More than 50 percent of the general
partners or joint venture parties are residents of Iowa for Iowa income tax purposes.
My business is an active corporation with the Iowa Secretary of State and has paid all fees
required by the Secretary of State, has filed its most recent biennial report, and has not filed
articles of dissolution.
My business is a corporation whose articles of incorporation are filed in a state other than Iowa,
the corporation has received a certificate of authority from the Iowa secretary of state, has filed
its most recent biennial report with the secretary of state, and has neither received a certificate of
withdrawal from the secretary of state nor had its authority revoked.
❑ Yes w 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 ['INo
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.
❑ Yes `t" 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 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 rN No My business is a limited liability company whose certificate of organization is filed in Iowa and has
not filed a statement of termination.
O Yes 6\No
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.
309-6001 (09-15)
BSF-2
Prime Contractor Name:
MBE/WBE BUSINESS ENTERPRISE
1f�{� PRE-BID CONTACT INFORMATION FORM
Y , vV�?cW(Project: N() 011 k
Letting Date: Nal 31))261°1
NO MBE/WBE SUBCONTRACTORS: If you are NOT using any MBENVBE subcontractors to complete this project, sign below. Attach a brief explanation
as to why subcontracting was not feasible with this project. If any MBEAVBE subcontractors will be used, please use the bottom portion of this form.
Contractor Signature: Title: 60 4M
Date:
012./)161
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 MBENVBE 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 MBENVBE 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
MBEIWBE BUSINESS ENTERPRISE CONTACTS
Quotes Received Quotation used in bid
MBE/WBE
Subcontractors
Dates
Contacted
Yes/No
Dates
Contacted
Yes/No
Dollar Amount Proposed to
be Subcontracted
'DC C9crpora4i o '-
50 /tom
N o
N 1 A
NO
Gyar Wal( is
5/u/Ilei
No
NIP\
No
Qui Cbl( aim
50(70Y+
NO
NIA
No
(Form CCO-4) Rev. 06-20-02
MBEIWBE PARTICIPATION
AECOM #60561525
M-6 of 6
City Contract No. 976
City of waterloo FY 2019 Jefferson and
Commercial Streetscape Improvements