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REINBECK, IOWA 50669-0155
CITY OF WATERLOO
CITY CLERK'S OFFICE
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FORM OF BID OR PROPOSAL
F.Y. 2020 DIGESTER #3 LID REMOVAL
CONTRACT NO. 982
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
4/..a0vock. , a Partnership consisting of the following partners:
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 F.Y. 2020 DIGESTER #3 LID
REMOVAL, Contract No. 982, all in accordance with the above -listed
documents and for the unit prices for work in place for the following items
and quantities:
F.Y. 2020 DIGESTER #3 LID REMOVAL
CONTRACT NO. 982
BID
ITEM
DESCRIPTION
UNIT
EST. QTY.
UNIT BID
PRICE
TOTAL BID PRICE
1
ALL WORK DESCRIBED
LS
1.00
S/ia,,ai
stiato, ,(o
Ott hat/clnes(
ttlitocktr
sty +coo
TOTAL BID
ektati °Die 06 ______
$ VI) 000.
�"
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 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
FORM OF BID
CONTRACT NO. 982 Page 1 of 3
2) The subcontractors submit in writing that they cannot fulfill their
subcontracts.
11. The bidder has filled in all blanks on this proposal. Those blanks not
applicable are marked "none" or "NA".
12. The bidder has attached all applicable forms.
13. The Owner reserves the right to select alternates, delete line items, and/or to
reduce quantities prior to the award of a contract due to budgetary
limitations.
BY:
cfcriv-k-f4S, XVIC, 64-11( /a01°1
(Name of Bidder) (Date)
Title OjYd AltCcf/gt✓
fficial Address: (Including Zip Code):
1011l hc. 54r#4-+
r-ketielbier 1 TO uJc.. 604/09
I.R.S. No. Ha-o9allvrSH
FORM OF BID
CONTRACT NO. 982 Page 3 of 3
Bidder Status Forrn
To be completed by all bidders
Part A
Please answer "Yes" or "No" for each of the following:
Yes ❑ No My company is authorized to transact business in Iowa.
(To help you determine if your company is authorized, please review the worksheet on the next page).
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.
IN Yes ❑ 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 ■ No My company is not a subsidiary of another business entity or my company is a subsidiary of another
business entity that would qualify as a resident bidder in Iowa.
If you answered "Yes" for each question above, your company qualifies as a resident bidder. Please
complete Parts B and D of this form.
If you answered "No" to one or more questions above, your company is a nonresident bidder. Please
complete Parts C and D of this form.
To be completed by resident bidders
Part B
My company has maintained offices in Iowa during the past 3 years at the following addresses:
Ccw',/\-gh- Address: 164' t3 ktc.kt1L(-1r S�-
City, State, Zip. k I I \Oe G -.. IA 1 -Th 6 613
Dates: / / to / / Address:
City, State, Zip:
Dates: / / to / / Address•
You may attach additional sheet(s) if needed. City, State, Zip.
nates:
I2 / Z2- / Ke5
to
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 ❑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 shoot(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: I (. -Cr Se /v l /OAvir h, S
Signature:
Date: 1/I//aa0/9
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 lowa Labor Commissioner.
309-6001 (09-15)
Worksheet: Authorization to Transact . usiness
This worksheet may be used to help complete PartA of the Resident Bidder Status form. If at least one of the following
describes your business, you are authorized to transact business in Iowa.
,JYes ❑ No My business is currently registered as a contractor with the Iowa Division of Labor.
❑ Yes i No
❑ Yes p No
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.
Yes ■ No My business is an active corporation with the Iowa Secretary of State and has paid all fees
required by the Secretary of State, has filed its most recent biennial report, and has not filed
articles of dissolution.
Yes [ 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 ILy No My business is a limited liability partnership which has filed a statement of qualification in this
state and the statement has not been canceled.
Yes
Yes [ No
Yes El No
Yes O No
Yes 'No
My business is a limited liability partnership which has filed a statement of qualification in a
state other than Iowa has filed a statement of foreign qualification in 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.
309-6001 (09-15)
MBE/WBE BUSINESS ENTERPRISE
PRE-BID CONTACT INFORMATION FORM
Prime Contractor Name: eg-td(4,[yn Cortkr'ecko1rA Inc Project: El aQao neer L:c ?tssating Date:
Ce..4.oa- ak : 98a
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 MBE/WBE subcontractors will be used, please use the bottom
portion of this form.
Contractor Signature:
Title: ojeaF UObte..tre Date: f,11/aC}I%
SUBCONTRACTORS AVPLICABLE: 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 Rudy Jones, 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
-VIBE/NYRE
Subcontractors
Dates
Contacted
Yes/No
Dates
Contacted
Yes/No
Dollar Amount Proposed to
be Subcontracted
No
MBE/(086
Swfxowilted. aor5
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(Form CCO 4) Rev. 06-20-02
NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
State of rOu70. )
County of Cou candy l
Awn Ntr•latk act
)ss
that:
, being first duly sworn, deposes and says
1. He is Owner Partner Officer Representativ- or Agent) of
tLrsor. l ovt(ns.3enr MAC. the Bidder that has sur e s 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
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 this affiant.
(Signed)
Subscribed and sworn to before me this
asA f 201j
TitleeM v
Nt
day of
My commission expires �r ('c2oa1
VALGREG DIRKS
I -Commission Number 740462
• My Commission Expires
May 01, 2021
BID BOND
KNOW ALL MEN BY THESE PRESENTS, that we, Peterson Contractors, Inc.
as Principal, and Travelers Casualty and Surety Company of America
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 ($ -_-500_-- ) 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 11th day of July
, 2019 for FY 2020 Digester #3 Lid Removal, Waterloo. IA - Contract No_,_982
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 fumish a bond for his faithful performance of said contract, and for the payment of all persons
performing labor or furnishing matenals in connection therewith, and shall in all other respects perform the
agreement created by the acceptance of said Bid,
Then this obligation shall be void, otherwise the same shall remain in force and effect; it being expressly
understood and agreed that the liability of the Surety for any and all claims hereunder shall, in no event,
exceed the penal amount of this obligation as herein stated.
By virtue of statutory authority, the full amount of this bid bond shall be forfeited to the Owner in liquidation of
damages sustained in the event that the Principal fails to execute the contract and provide the bond as
provided in the specifications or by law.
The Surety, for value received, hereby stipulates and agrees that the obligations of said Surety and its bond
shall be in no way impaired or affected by any extension of the time within which the Owner may accept
such Bid or execute such contract; and said Surety does hereby waive notice of any such extension.
IN WITNESS WHEREOF, the Principal and the Surety, have hereunto set their hands and seals, and such
of them as are corporations, have caused their corporate seals to be hereto affixed and these presents to be
signed by their proper officers this 2nd day of July , A.D. 2019 ,
Witness
An
Witness Emilie Cooper
(1
4 -)aiter
By
Peterson Contractors, Inc.
Principo I
(Seal)
president (Title)
Traveler tL ualty and Suretf?ompany of t\istrAT
1
S rety
Attorneys n -fact, Diyne R. Young
TRAVELERS J
Travelers Casualty and Surety Company of America
Travelers Casualty and Surety Company
St. Paul Fire and Marine Insurance Company
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St.
Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively called the
"Companies"), and that the Companies do hereby make, constitute and appoint Dione R. Young of Waukee
Iowa their true and lawful Attorney -in -Fact to sign, execute, seal and acknowledge any and all bonds, recognizances,
conditional undertakings and other writings obligatory 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.
IN WITNESS WHEREOF, the Companies have caused this instrument to be signed, and their corporate seals to be hereto affixed, this 17th day of January,
2019..
State of Connecticut
By:
City of Hartford ss.
On this the 17th day of January, 2019, before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President
of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company, and
that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of said
Companies by himself as a duly authorized officer.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
My Commission expires the 30th day of June, 2021
Robert L. RanetSenior Vice President
Anna P. Nowik, Notary Public
This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Travelers Casualty and
Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company, which resolutions are now in full
force and effect, reading as follows:
RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any
Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys -in -Fact and
Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign
with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a
bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke
the power given him or her; and it is
FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice
President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such
delegation is in writing and a copy thereof is filed in the office of the Secretary; and it is
FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional
undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any
Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any
Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if
required) by one or more Attorneys -in -Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one
or more Company officers pursuant to a written delegation of authority; and it is
FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice
President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power of
Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys -in -Fact for purposes only of
executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such Power of Attorney or certificate bearing
such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile
signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached.
I, Kevin E. Hughes, the undersigned, Assistant Secretary of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety
Company, and St. Paul Fire and Marine Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of the Power of
Attorney executed by said Companies, which remains in full force and effect.
Dated this 1st day of July , 2019
Kevin E. Hughes, Assistant Secretary
To verify the authenticity of this Power of Attorney, please cat/ us at 1-800-421-3880.
P/ease refer to the above-named Attorney -in -Fact and the details of the bond to which this Power of Attorney is attached.