HomeMy WebLinkAboutPeterson Contractors, Inc.Wak
VAMIK.ORS
BOX A
REINBECK, IOWA 50669-0155
Dry Run Creek Interceptor
Contract No. 877
Waterloo, IA
Bid Due11-7-19 @ 1PM
City of Waterloo, IA
Bid Proposal
EZEYA
V7ANkANkS1C.14lica
AHC.
BOX A
REINBECK, IOWA 50669-0155
•
Dry Run Creek Interceptor
Contract No. 877
Waterloo, IA
Bid Due11-7-19 @ 1PM
City of Waterloo, IA
Bid Bond
FORM OF BID OR PROPOSAL
DRY RUN CREEK INTERCEPTOR
CONTRACT NO. 877
CITY OF WATERLOO, IOWA
Honorable Mayor and City Council
Waterloo, Iowa
Gentlemen:
Revised Per Addendum #4 - 11/01/2019
The undersigned, being a Corporation existing under the laws of the State of Iowa 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
DRY RUN CREEK INTERCEPTOR, CITY CONTRACT NO. 877, all in accordance with the above -listed
documents and for the unit prices for work in place for the following items and quantities:
DRY RUN CREEK INTERCEPTOR
Item
No.
Description
Unit
Estimated
Quantity
Unit
Price
Total
Price
1
Mobilization
LS
1.0
$
$
2
Traffic Control
LS
1.0
$
$
3
Clearing and Grubbing
LS
1.0
$
$
4
Existing Pump Vault, Valve Vault and Equalization
Tank Removal
LS
1.0
$
$
5
Import Fill for Lift Station Site
CY
254.8
$
$
6
Import Fill for Trench Removals
CY
5,800.0
$
$
7
Lift Station Wet Well and Valve Vault
LS
1.0
$
$
8
Electrical Equipment Building
LS
1.0
$
$
9
Site Electrical
LS
1.0
$
$
10
Stand -By Generator
LS
1.0
$
$
11
Metering Manhole
LS
1.0
$
$
12
Air Release Manhole
LS
1.0
$
$
13
Retaining Wall
LS
1.0
$
$
14
Unclassified Material (Removal of Rippable Rock)
CY
2,500
$
$
15
Foundation Rock
TON
82.0
$
$
16
Trench Compaction Testing
LS
1.0
$
$
FORM OF BID
AECOM #60330823 (2019)
CONTRACT NO. 877
FB -1 OF 4
DRY RUN CREEK INTERCEPTOR
Revised Per Addendum #4 - 11/01/2019
DRY RUN CREEK INTERCEPTOR
Item
No.
Description
Unit
Estimated
Quantity
Unit
Price
Total
Price
17
Abandon and Plug 8 -Inch Sanitary Sewer
LF
215.0
$
$
18
Sanitary Sewer Force Main Testing
LS
1.0
$
$
19
Cleaning, Inspection
Sewer Gravity Mains
and Testing of Sanitary
LS
1.0
$
$
20
24 -Inch Sanitary Sewer Gravity Main - Open Cut
LF
5,178.7
$
$
21
24 -Inch Sanitary Sewer Gravity Main - Directional
Drilling
LF
754.9
$
$
22
20 -Inch Sanitary Sewer Gravity Main Ductile Iron -
Open Cut
LF
92.0
$
$
23
18 -Inch Sanitary Sewer Gravity Main - Open Cut
LF
2,399.2
$
$
24
12 -Inch Sanitary Sewer Force Main - Directional
Drilling
LF
524.0
$
$
25
12 -Inch Sanitary Sewer Force Main - Open Cut
LF
1,958.0
$
$
26
8 -Inch Sanitary Sewer Gravity Main - Open Cut
LF
43.0
$
$
27
6 -Inch Sanitary Sewer Gravity Main Ductile Iron -
Open Cut
LF
15.0
$
$
28
30 -Inch Steel Casing, With 18 -Inch Sanitary
Sewer Gravity Main
LF
235.0
$
$
29
24 -Inch Steel Casing, With 12 -Inch Sanitary
Sewer Force Main
LF
196.0
$
$
30
Force Main Fittings
LBS
655.0
$
$
31
48 -Inch Manhole Replacement
EA
2.0
$
$
32
72 -Inch Manhole Replacement
EA
1.0
$
$
33
48 -Inch Manhole
EA
28.0
$
$
34
24 -Inch
SW -604,
Circular Area Intake - SW -512, With
Type 3B
EA
1.0
$
$
35
Connection to Existing Sanitary Manhole
EA
4.0
$
$
36
8 -Inch Drop Connection
EA
1.0
$
$
37
24 -Inch RCP Storm Sewer
LF
20.0
$
$
38
24 -Inch RCP Apron
EA
1.0
$
$
39
18 -Inch RCP Storm Sewer
LF
20.0
$
$
40
18 -Inch RCP Apron
EA
2.0
$
$
41
12 -Inch RCP Storm Sewer
LF
32.0
$
$
42
12 -Inch RCP Apron
EA
1.0
$
$
43
Drain Tile Replacement
LF
80.0
$
$
FORM OF BID
AECOM #60330823 (2019)
CONTRACT NO. 877
FB -2 OF 4
DRY RUN CREEK INTERCEPTOR
Revised Per Addendum 44 •11101/2019
?leas' ��,t A*aackLT4omis ,l,
It is understood that the quantities set forth are approximate only and subject to va dation and that the
unit bid price for the work done shall govern in the actual payment to Contractor.
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.
FORM OF BID
AECOM #60330823 (2019)
CONTRACT NO. 877 FB -3 OF 4
DRY RUN CREEK INTERCEPTOR
DRY RUN CREEK INTERCEPTOR
Item
No.
Description
Unit
Estimated
Quantity
Unit
Price
Total
Price
44
6 -Inch PCC Pavement
SY
477.0
$
$
45
8 -Inch PCC Pavement
SY
130.0
$
$
46
8 -Inch HMA Pavement
SY
71.0
$
$
47
Gravel Surfacing
SY
198.0
$
$
48
Crushed Stone - Class "A"
SY
477.0
$
$
49
Pavement Removal
SY
201.0
$
$
50
Seeding, Fertilizing and Mulching for Hydraulic
Seeding - Type 1 Seed Mix
AC
6.1
$
$
51
Seeding, Fertilizing and Mulching for Hydraulic
Seeding - Type 2 Seed Mix
AC
5.7
$
$
52
Seeding, Fertilizing and
Seeding - Type 4 Seed Mix
Mulching for Hydraulic
AC
6.1
$
$
53
Seeding, Fertilizing and Mulching
Seeding - Type 5 Seed Mix
for Hydraulic
AC
5.7
$
$
54
Erosion Stone
SY
240.0
$
$
55
Silt Fence
LF
6,700.0
$
$
56
Temporary Rolled Erosion Control Products
(RECP)
SY
51,860.0
$
$
57
SWPPP Requirements
LS
1.0
$
$
58
6 -Foot Chain -Link Fence
LF
233.0
$
$
59
24 -Foot Chain -Link Gate
EA
2.0
$
$
60
Texas St. Lift Station Generator
LS
1.0
$
$
61
Rock Excavation
CY
1,500
$
$
TOTAL BID
AMOUNT
$$10t
co
/2Ua
?leas' ��,t A*aackLT4omis ,l,
It is understood that the quantities set forth are approximate only and subject to va dation and that the
unit bid price for the work done shall govern in the actual payment to Contractor.
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.
FORM OF BID
AECOM #60330823 (2019)
CONTRACT NO. 877 FB -3 OF 4
DRY RUN CREEK INTERCEPTOR
Bidder Status Form
To be completed by all bidders Part A
Please answer'
Yes ❑ No
® Yes ❑ No
[]Yes jNo
I Yes ❑ No
(XYes n No
'Yes" or "No" for each of the following:
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 Bit
My company has maintained offices in Iowa during the past 3 years at the following addresses:
Dates: l2 / 2 / Iq > to I / 7 / 20 n Address: 11)4- .00.4c Ravak St
City, State, Zip `1121n�.2G1C 60C11
Address:
City, State, Zip:
Address:
City, State, Zip:
Dates:
/ to /
Dates: / / to
You may attach additional sheet(s) if needed.
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?
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.
Yes I I No
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:
7p aniaaL
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.
309-6001 (09-15)
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.
pz Yes ❑ No
1 Yes NI No
❑Yes MNo
[Yes ❑ No
Yes IX 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.
n Yes 4 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 X 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.
Yes 14 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.
n Yes 171 No
n Yes cg No
n Yes IA 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.
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)
BSF-2
Page 2
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
STATE
REVOLVING FUND
(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 lots, 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).
/!/"71/9
S ignature /Date
N ame and Title of Signer (Please Type)
N OTE: The penalty for making false statements in offers is prescribed in 18 U.S.C. 1001.
EPA -7 5720-4.2
INVESTING IN IOWA'S WATER
May 2015
Page 3
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 REVOLVING ONO
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.
SRF
STATE
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.
� ck,b2 -- ah,e CA.( ANCLVal/ (\Awnacgex-
Typed Name & Title of Authorized RePresentative
Signature of Authorized Representative Da
I am unable to certify to the above statements. My explanation is attached.
EPA Form 5700 49 (11-88)
INVESTING IN IOWA'S WATER
May 2015
Page 4
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
STATE
REVOLVING FUVO
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.lowadot.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.lowadot.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:
Bidder:
Address:
Contact Person:
Signature:
Phone Number:
E -Mail Address:
Check if Prime Contractor is: ❑ Minority -Owned
Women -Owned
❑
INVESTING IN IOWA'S WATER
May 2015
Page 5
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? [p Yes No
STATE
REVO VING FUND
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. LI Yes I 1 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 particip tion by DBEs in the
competitive process. T. Yes 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? n Yes [4 No
5. Did you use the services of the Small Business Administration and the Minority Business
Development Agency of the Department of Commerce to identify potential subcontractors?
Yes KI 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)
`
ie...,-- �IAr
t�heie
2`vetielse
tau;%
tC i'mrp
)
�lno-n4e
R�r3et)
a �surte
PROPOSED UTILIZATION OF DBE SUBCONTRACTORS
Please include Attachments 4 and 5 to document the proposed utilization of certified DBE
subcontractors.
INVESTING IN IOWA'S WATER
May 2015
Page 6
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.
STATE
REVOLVING FUND
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.
INVESTING IN IOWA'S WATER
May 2015
Page 7
Attachment 4
SRF Required Front -End Specifications
(This form must be completed and signed by Prime and
DOE Subcontractor for each subcontract and submitted with the bid.)'
STATE
REVD U ?i0. U t0
OMB Cont of 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's? 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
Vint
Bid/Proposal No.
Project Name
Iv/ 2L'en ('r
,.Ir: C- .4i e •
9 7 7
Assistance Agreement ID No. l Point of Contact
Of known)ra9�
1
Address
Cat
:11C1117 14 S'1 1,>fv.mAt
f/v..?, r. t3vd/7 ,"l_!1 .'L/$„ ,
Telephone No.q2
C319) 352
t ` (
,,-C46
EmailAddress
Joh, 12rq-e/infrfs .ry'isi ty.rrc; l [cvr%7
Issuing/Funding Entity
Prime Contractor
Name
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
DBE Certified by
Other:
DOT SBA
Meets/exceeds EPA certification
YES
NO
standards?
Unknown
_._.
'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
INVESTING IN IOWA'S WATER
May 2015
Page 8
STATE
OMB Cont of 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
Subcontractor Signature
Print Name
Print Name
`
Title '
Date
Pro. \I
.4 ,.^617-
0.40,...1 617-
/ 047
Title
Date
aNtAACALC iThanCIer
((/7
719
-� k1/41e4
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
INVESTING IN IOWA'S WATER
May 2015
Subcontractor Signature
Print Name
`
Title '
Date
Pro. \I
.4 ,.^617-
0.40,...1 617-
/ 047
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
INVESTING IN IOWA'S WATER
May 2015
Page 7
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.)
STATE
REVOLVING FUND
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
Ibt.„ Cetp
Project Name
DI Rah LrttL .
-/n`(`,aC-c�pk
Or
Bid/Proposal No.
Assistance Agreement ID No.
(if known)
Point of Contact
Address
(-(v, geeclz S.1Waterloo ,t1 50703
Telephone No.
(3I9) yq.5 a.54 -}Z
Email Address
6/J,PAr
Primmee ContractorName
/
Issuing/Funding Entity
Contract Item
Number
Description of Work Submitted to the Prime Contractor Involving
Construction, Services Equipment or Supplies
Price of Work Submitted to
the Prime Contractor
DBE Certified
/\ Other:
by
DOT SBA
Meets/exceeds EPA certification standards?
YES NO %C Unknown
n
(,(,(xvLL
e4(b
1A DBE is a Disadvantaged, Minority, or Woman Business Enterp ise 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
INVESTING IN IOWA'S WATER
May 2015
Page 8
STATE
REVOLVING FUND
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
Title
Date
't�XMti` e--
n
ell*
�✓ r
�1
L��j�l‘
Title
Date
Csojer
\tnetv,a /k
,, (Z /,�j
Anedvoir
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
INVESTING IN IOWA'S WATER
May 2015
Page 9
Attachment 5
SRF Required Front -End Specifications
(This form must be completed and signed by Prime Contractor and sub
with the bid if utilizing DBE subcontractors.)
SRF
STATE
REVOLVING FUND
OMB Cont of 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.
Continue on back if needed
'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 6100-4 (DBE Subcontractor Utilization Form) — Page 1
INVESTING IN IOWA'S WATER
May 2015
Pr'me
Contractor
Namerr��
111
�� :TOG
Project Name
Drti Rwik l p 51'2.JL1�'Q.dt'e
zr
Bid/P oposal No.
Assistiance Agreement ID No.
(if known)
Poin
0,1flS
of
Contact
i
\�W—
Address�nn
VI ��
evW1
%loct
4jAbi.CI t
f
-rl
Telephone No.
(Sro 705.- L1771
Email Address
c--Res,ww- & (As icon
Issuing/Funding Entity
I have identified potential DBE certified subcontractors
If yes, please complete the table below. If no, please explain:
�( YES
NO
Subcontractor
Name/Company
Name
Company Address/Phone/Email
Estimated Dollar
Amount
Currently DBE
Certified?
kA l‘kuiezeti
r94iC\ E
minNix Ave. 14Akkki m 501077
II
1.b0, 000 .
%.
O Csrp&ra &.,
,
Litt° btileri>> Si : Luaderiao/ 7E X70-5
445,000,
.)
Continue on back if needed
'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 6100-4 (DBE Subcontractor Utilization Form) — Page 1
INVESTING IN IOWA'S WATER
May 2015
Page 10
STATE
REVO VINO ND
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
ULATavisr-----
brGS Th. PleShr\e-
Title
Date
���
/ &Nailer
U / .7 !
t -t
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
INVESTING IN IOWA'S WATER
May 2015
ff'' ,, NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
State of l O W A
County of gr a NOT' r
akin S 0 F1 e Skov
being first duly sworn, deposes and says that:
He is f (Owner, "Deane , Officer, Representative, or Agent)
of Pt P I/QM l,(mfrat(WYV I (rile Bidder that has submitted the attached Bid;
He is fully 'nformed 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
My commission expires
NON -COLLUSION AFFIDAVITS
AECOM #0330823 (2019)
Title
day of NOR rn k ft 20 9
P.ui P Cam(,or Assisf
,,j$ft., JENNIFER R WISSLER1
1" c•Commisslon Number 761292
1 1
c My Commission Expires
January 04, 2022
CONTRACT NO. 877 NCA -1 OF 2
DRY RUN CREEK INTERCEPTOR
MBE/WBE BUSINESS ENTERPRISE
_ PRE-BID CONTACT INFORMATION FORM
Prime Contractor Name:? 6f3,m't J7rt' L25 iJte- Project:;l�ryRue CALziL�tierceptc Letting Date: I/771
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/WBE subcontractors will be used, please use the bottom
portion of this form.
Contractor Signature: V(] �1y��jt dt„ Title: -leaf Moo Date: 117/9
SUBCONTRACTORS APPLICABLE: You are required, in order for your bid to be considered responsive, to provide the information on this form
showing ALL of your MBE/WBE subcontractor contacts made for your bid submission. This information is subject to verification. Any questions
should be directed to Contract Compliance Office 319-291-4429.
You are required, in order for your bid to be considered responsive, to provide the information on this Form showing your MBE/WBE Business
Enterprise contacts made prior to your bid submission. This information is subject to verifications and confirmation.
If you are unable to identify MBENVBE 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
se>u,
/0y' hai
1i
it /0 719
(1
4130Ooo eev-
l eA'L Xt•u
` e- bereciu"n
to/) it
0
II hall (
Li�C �
(Form CCO-4) Rev. 06-20-02
MBE/VVBE PARTICIPATION
AECOM #60330823 (2019)
CONTRACT NO. 877
MBE -6 OF 6
DRY RUN CREEK INTERCEPTOR
PETERSON CONTRACTORS, INC.
www. petersoncontractors. corn
104 Blackhawk Street
P.O. BoxA
Reinbeck, Iowa 50669
Phone: 319-345 2713
QUOTE
PROPOSAL FOR: Dry Run Creek Interceptor Contract No. 877
THE FOLLOWING ITEMS AND PRICES ARE QUOTED:
ITEM # DESCRIPTION
1 MOB
2 TRAFFIC CONTROL
3 CLEARING & GRUBBING
4 EXISTING PUMP VAULT VALVE VAULT
5 IMPORT FILL FOR LIFT STATION SI
6 IMPORT FILL FOR TRENCH REMOVALS
7 LIFT STATION WET WELL & VALVE V
8 ELECTRICAL EQUIPMENT BUILDING
9 SITE ELECTRICAL
10 STAND-BY GENERATOR
11 METERING MANHOLE
12 AIR RELEASE MANHOLE
13 RETAINING WALL
14 UNCLASSIFIED MATERIAL (REMOVAL
15 FOUNDATION ROCK
16 TRENCH COMPACTION TESTING
17 ABANDON & PLUG 8" SANITARY SEWE
18 SANITARY SEWER FORCE MAIN TESTI
19 CLEANING INSPECTION & TESTING 0
20 24" SANITARY SEWER GRAVITY MAIN
21 24" SANITARY SEWER GRAVITY MAIN
22 20" SANITARY SEWER GRAVITY MAIN
23 18" SANITARY SEWER GRAVITY MAIN
24 12" SANITARY SEWER FORCE MAIN -
25 12" SANITARY SEWER FORCE MAIN -
26 8" SANITARY SEWER GRAVIITY MAIN
27 6" SANITARY SEWER GRAVITY MAIN
28 30" STEEL CASING / 18" SANITARY
29 24" STEEL CASING / 12" SANITARY
30 FORCE MAIN FITTINGS
31 48" MANHOLE REPLACEMENT
32 72" MANHOLE REPLACEMENT
33 48" MANHOLE
34 SW -512 - 24" CIRCULAR AREA INTA
35 CONNECTION TO EXISTING SANITARY
36 8" DROP CONNECTION
37 24" RCP STORM SEWER
38 24" RCP APRON
39 18" RCP STORM SEWER
40 18" RCP APRON
41 12" RCP STORM SEWER
42 12" RCP APRON
43 DRAIN TILE REPLACEMENT
44 6" PCC PAVING
UNIT TYPE
LS
LS
LS
LS
CY
CY
LS
LS
LS
LS
LS
LS
LS
CY
TN
LS
LF
LS
LS
LF
LF
LF
LF
LF
LF
LF
LF
LF
LF
LBS
EA
EA
EA
EA
EA
EA
LF
EA
LF
EA
LF
EA
LF
SY
QUANTITY
1.000
1.000
1.000
1. 000
254.800
5, 800. 000
1. 000
1.000
1.000
1.000
1. 000
1. 000
1.000
2,500.000
82.000
1. 000
215. 000
1. 000
1. 000
5, 178.700
754.900
92.000
2, 399. 200
524.000
1, 958. 000
43.000
15.000
235.000
196.000
655.000
2.000
1. 000
28.000
1.000
4. 000
1. 000
20.000
1.000
20.000
2.000
32. 000
1. 000
80.000
477.000
UNIT PRICE
150, 000. 00
15, 000. 00
25, 000. 00
175,000.00
12.50
32.50
700,000.00
165,000.00
250, 000. 00
115,000.00
50, 000.00
45, 000. 00
145, 000. 00
65.00
35.00
30, 000. 00
50.00
25, 000. 00
35, 000.00
105. 00
2, 050. 00
300.00
80.00
180.00
65. 00
140. 00
165.00
835.00
550.00
10.00
17, 500.00
20 000.00
8, 500. 00
2, 500. 00
8, 000. 00
9, 500. 00
220.00
3, 000.00
210. 00
2, 750. 00
200.00
2, 600. 00
15.00
70.00
Fax: 319-345-2991
TOTAL AMOUNT
150, 000.00
15, 000. 00
25, 000. 00
175,000. 00
3, 185. 00
188,500.00
700,000.00
165,000.00
250,000.00
115, 000. 00
50, 000. 00
45, 000.00
145,000.00
162,500.00
2, 870. 00
30, 000. 00
10, 750. 00
25, 000. 00
35, 000. 00
543, 763. 50
1, 547, 545.00
27, 600. 00
191,936.00
94, 320. 00
127,270.00
6 020.00
2, 475. 00
196,225.00
107,800.00
6, 550. 00
35, 000. 00
20, 000. 00
238, 000.00
2, 500.00
32, 000.00
9, 500. 00
4, 400. 00
3, 000. CO
4, 200. 00
5, 500. 00
6, 400. 00
2, 600.00
1, 200.00
33, 390.00
PCI QUOTE ON Dry Run Creek Interceptor Contract No. 877 - Continued
ITEM # DESCRIPTION
45 8" PCC PAVING
46 8" HMA PAVEMENT
47 GRAVEL SURFACING
48 CLASS A CRUSHED STONE
49 PAVEMENT REMOVAL
50 TYPE 1 HYDRAULIC SEED FERT & MU
51 TYPE II HYDRAULIC SEED FERT & M
52 TYPE IV HYDRAULIC SEED FERT & M
53 TYPE V HYDRAULIC SEED FERT & MU
54 EROSION STONE
55 SILT FENCE
56 TEMPORARY ROLLED EROSION CONTRO
57 SWPPP REQUIREMENTS
58 6' CHAIN LINK FENCE
59 24' CHAIN LINK GATE
60 TEXAS ST LIFT STATION GENERATOR
61 ROCK EXCAVATION
TOTAL QUOTED AMOUNT:
PETER •N CONTRACTORS, INC.
November 07,2019
UNIT TYPE
SY
SY
SY
SY
SY
AC
AC
AC
AC
SY
LF
SY
LS
LF
EA
LS
CY
QUANTITY
130.000
71. 000
198.000
477.000
201.000
6.100
5.700
6.100
5. 700
240.000
6,700.000
51, 860.000
1. 000
233.000
2.000
1.000
1,500.000
UNIT PRICE
90.00
115.00
16.00
16.00
22.50
3, 500.00
2, 850. 00
1, 950. CO
2, 000. 00
40.00
2.25
1.00
10 000. 00
30.00
1, 30(1 00
475,000.00
100.00
TOTAL AMOUNT
11,700.00
8, 165. 00
3, 168. 00
7, 632.00
4, 522. 50
21, 350. 00
16, 245. 00
11, 895. 00
11,400.00
9, 600. 00
15, 075. 00
51,860.00
-10, 000. 00
6, 990. 00
2, 600. 00
475,000.00
150,000.00
$ 6, 359, 202. 00
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 Amount Bid
Dollars
($ 50/0 ) 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 November
, 20 19 , for Dry Run Creek Interceptor, City of Waterloo, IA; Contract No. 877
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 22nd day of October , A.D. 20 19 .
=1ws�o�
L9cucLjLQp
Peterson Contractors, Inc.
principal
By C
(Seal)
(Title)
president
avelers Casualty and Surety Company of America (Seal)
Sur' -
Witness Dione R. Youhg
BID BOND
AECOM #60330823 (2019)
Attorney-in-fact Anne Crowner
CONTRACT NO. 877 BB -1 OF 1
DRY RUN CREEK INTERCEPTOR
TRAVELERS .1
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 13Y 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 Anne Crowner 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.
"try
wa•F..'Yi
HARTFORD,
cOMMM.
• %ON
la.6
State of Connecticut
City of Hartford ss.
By:
Robert L. RaneV'Senior Vice President
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, 1 hereunto set my hand and official seal.
My Commission expires the 30th day of June, 2021
a•.hP Np. +,
ett't `�Lt•.
*I fta 4f7. 1-4
•nj� I '
� pUP.UO
,,,�iS+�Ean�;�1
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 22nd day of October
2019
Kevin E. Hughes, Assistant Secretary
To verify the authenticity of this Power ofAttorney, p/ease call us at 1-800-421-3880.
Please refer to the above-named Attorney -in -Fact and the details of the bond to which this Power ofAttorney is attached.