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HomeMy WebLinkAboutWoodruff Construction, LLCm N O N O oE- -5;0 v v o CD � 0 o -4 vD aB N z0 O rr ci CD DJ r o 0) 0 a 0D 1 W00DRUFF CONSTRUCTION LLC Woodruff Construction 1717 Falls Ave Waterloo, IA 50701 ENCLOSED: 1. Form of Bid 2 Bidder Status Form 3. Non -Collusion Affadavit 4. MBE/WBE Pre -Bid Contact Information Form and Copies of Solicitation Letters sent 5 Equal Opportunity Clause 6. SRF Attachments 1, 2, 3, 4, 5 To: City Clerk City of Waterloo, Iowa 715 Mulberry Street Waterloo, IA 50703 BID for: FY 2020 Waterloo Wastewater Treatment Plant Biosolids Modifications City Contract No. 994 City of Waterloo, Iowa • BID BOND K NOW ALL MEN BY THESE PRESENTS, that we, Woodruff Construction, LLC as Principal, and United Fire & Casualty Company as Surety are held and firmly bound unto the CITY OF WATERLOO , Iowa, hereinafter called "OWNER." In the penal sum Five Percent of the Bid Amount D ollars ($ 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 23rd day of January , 20 20 , for F.Y. 2020 Wastewater Treatment Plant Biosolids Modifications, City Contract No. 994, City of Waterloo, Waterloo, Iowa N OW, 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 presents to be signed by their proper officers this 0th day of January , A.D. 20 20 . Witness BID BOND Stacy Venn Woodruff Construction, LLC Principal By Donald A.Woodruff United Fire & Casualty Company Surety By (Seal) PrPSid n (Title) Attorney-in-fact Dione R. Young Section BB -1 4463.004/City Contract No. 994 _(Seal) UNITED FIRE & CASUALTY COMPANY, CEDAR RAPIDS, IA UNITED FIRE & INDEMNITY COMPANY, WEBSTER, TX FINANCIAL PACIFIC INSURANCE COMPANY, ROCKLIN, CA CERTIFIED COPY OF POWER OF ATTORNEY (original on file at Home Office of Company — See Certification) KNOW ALL PERSONS BY THESE PRESENTS, That UNITED FIRE & CASUALTY COMPANY, a corporation duly organized and existing under the laws of the State of Iowa; UNITED FIRE & INDEMNITY COMPANY, a corporation duly organized and existing under the laws of the State of Texas; and FINANCIAL PACIFIC INSURANCE COMPANY, a corporation duly organized and existing under the laws of the State of California (herein collectively called the Companies), and having their corporate headquarters in Cedar Rapids, State of Iowa, does make, constitute and appoint CRAIG E. HANSEN, JAY D FREIERMUTH, BRIAN M. DEIMERLY, CINDY BENNETT, ANNE CROWNER, TIM MCCULLOH, STACY VENN, SHIRLEY BARTENHAGEN, DIONE R. YOUNG, KEVIN J. KNUTSON, MICHELLE GRUIS, KATHLEEN BREWER, SETH D. ROOKER, SYDNEY BURNETT, EACH INDIVIDUALLY Inquiries: Surety Department 118 Second Ave SE Cedar Rapids, IA 52401 their true and lawful Attorney(s)-in-Fact with power and authority hereby conferred to sign, seal and execute in its behalf all lawful bonds, undertakings and other obligatory instruments of similar nature provided that no single obligation shall exceed $100,000,000.00 and to bind the Companies thereby as fully and to the same extent as if such instruments were signed by the duly authorized officers of the Companies and all of the acts of said Attorney, pursuant to the authority hereby given and hereby ratified and confirmed. The Authority hereby granted is continuous and shall remain in full force and effect until revoked by UNITED FIRE & CASUALTY COMPANY, UNITED FIRE & INDEMNITY COMPANY, AND FINANCIAL PACIFIC INSURANCE COMPANY. This Power of Attorney is made and executed pursuant to and by authority of the following bylaw duly adopted on May 15, 2013, by the Boards of Directors of UNITED FIRE & CASUALTY COMPANY, UNITED FIRE & INDEMNITY COMPANY, and FINANCIAL PACIFIC INSURANCE COMPANY. "Article VI — Surety Bonds and Undertakings" Section 2, Appointment of Attorney -in -Fact. "The President or any Vice President, or any other officer of the Companies may, from time to time, appoint by written certificates attorneys -in -fact to act in behalf of the Companies in the execution of policies of insurance, bonds, undertakings and other obligatory instruments of like nature. The signature of any officer authorized hereby, and the Corporate seal, may be affixed by facsimile to any power of attorney or special power of attorney or certification of either authorized hereby; such signature and seal, when so used, being adopted by the Companies as the original signature of such officer and the original seal of the Companies, to be valid and binding upon the Companies with the same force and effect as though manually affixed. Such attorneys -in -fact, subject to the limitations set forth in their respective certificates of authority shall have full power to bind the Companies by their signature and execution of any such instruments and to attach the seal of the Companies thereto. The President or any Vice President the Board of Directors or any other officer of the Companies may at any time revoke all power and authority previously given to any attorney-in-fact. IN WITNESS WHEREOF, the COMPANIES have each caused these presents to be signed by its \``8cmr""'� "",*`nk,,, ', "'� iNs""' ; vice president and its corporate seal to be hereto affixed this 15`h day of January, 2014 tia Zom EUS i�LY 22 0:.3_ .• 7 ▪ SEAL : Z' • 01986 +a �'1U dsrf.¢TE0 9 \P.'2 UNITED FIRE & CASUALTY COMPANY UNITED FIRE & INDEMNITY COMPANY FINANCIAL PACIFIC INSURANCE COMPANY By: State of Iowa, County of Linn, ss: Vice President On 15th day of January,2014, before me personally came Dennis J. Richmann to me known, who being by me duly sworn, did depose and say that he resides in Cedar Rapids, State of Iowa; that he is a Vice President of UNITED FIRE & CASUALTY COMPANY a Vice President of UNITED FIRE & INDEMNITY COMPANY, and a Vice President of FINANCIAL PACIFIC INSURANCE COMPANY the corporations described in and which executed the above instrument that he knows the seal of said corporations; that the seal affixed to the said instrument is such corporate seal; that it was so affixed pursuant to authority given by the Board of Directors of said corporations and that he signed his name thereto pursuant to like authority, and acknowledges same to be the act and deed of said corporations. rwa Judith A. Jones Iowa Notarial Seal Commission number 173041 My Commission Expires 04/23/2021 Notary Public My commission expires: 04/23/2021 I, Mary A. Bertsch, Assistant Secretary of UNITED FIRE & CASUALTY COMPANY and Assistant Secretary of UNITED FIRE & INDEMNITY COMPANY, and Assistant Secretary of FINANCIAL PACIFIC INSURANCE COMPANY, do hereby certify that I have compared the foregoing copy of the Power of Attorney and affidavit, and the copy of the Section of the bylaws and resolutions of said Corporations as set forth in said Power of Attorney, with the ORIGINALS ON FILE IN THE HOME OFFICE OF SAID CORPORATIONS, and that the same are correct transcripts thereof, and of the whole of the said originals, and that the said Power of Attorney has not been revoked and is now in full force and effect. In testimony whereof I have hereunto subscribed my name and affixed the corporate seal of the said Corporations this 0th day of January 2020 11 • SEAL O44 ♦ • ' h 5 B , ♦ '''���h/r I Ill f \\"♦♦♦ 01111 Sias"4, 490 CORPORATE 14.2.>. a w fz 3� 49 CVIII'ORATE �• SEAL BPOA0049 0913 zEt By: Assistant Secretary UF&C & OF&I & FPIC FORM OF BID oR PROPOSAL F.Y. 2020 WASTEWATER TREATMENT PLANT BIOSOLIDS MODIFICATIONS CITY OF WATERLOO, IOWA MY Y CONTRACT NO. 994 Honorable Mayor and City Council Waterloo, Iowa 1. The undersigned, being a Corporation existing under the laws of the State of Iowa a Partnership consisting of the following partners: Woodruff Construction, IsLC , 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 Wastewater Treatment Plant Biosolids Modifications, City Contract No. 994, all in accordance with the above -listed documents and for the lump sum base bid cost: LUMP SUM BASE BID. 4tArQ Imwl dolla\rs� si kf-ee rs wi lio h -'vg ktmckreet ei:9tlHa 42-oer) tt1ot/Dollars $oto 537) 3 c• 00 Words umbers See Section 01 29 00—Contract Considerations for discussion of cash allowances to include in the Bid. Contract award will be made based on the Lump Sum Base Bid or Lump Sum Base Bid with any combination of Bid Alternatives selected. The price for all Base Bid Equipment items shall be included in the Lump Sum Base Bid. Bid Alternatives will be added or deducted from the Lump Sum Base Bid, if they are accepted, prior to Notice of Award being made. CITY reserves the right to accept or reject any Bid Alternatives or Equipment Alternatives to the Lump Sum Base Bid. Should CITY wish to consider Bid Alternatives listed, Bidder may be required to provide additional information prior to Notice of Award. Consideration of Equipment Alternatives of the selected Bidder will be made by CITY within 60 days after the Effective Date of the Agreement. If a Bid Equipment Alternative is selected by CITY, the awarded Contract price will include the selected Alternative(s). FORM OF BID Section BF -1 4463.004/City Contract No_ 994 2. Bid Alternatives B ID ALTERNATIVE NO. 1: CONTRACTOR shall include in the cost of the Bid Alternative ALL work associated with providing the scope listed below. The price of $6y9 oDb .00) shall be deducted from the Contract Lump Sum Base Bid if CITY elects to have CONTRACTOR eliminate the addition of the metal canopy, framing, wall panels, concrete walls and footings associated with the outdoor biosolids loadout area located between the Dewatering Building (Structure 330) and the Centrate Equalization Tanks (Structure 350) as indicated in the Drawings and in the S pecifications as specked in Section 07 61 00—Sheet Metal Roofing and Section 41 1213—Shaftless Screw Conveyors. B ID ALTERNATIVE NO. 2: CONTRACTOR shall include in the cost of the Bid Alternative ALL work associated with providing the scope listed below. Theprice of $g 0 ..�.s .00 shall be deducted from the Contract Lump Sum Base Bid if CITY elects to have CONTRACTO eliminate the addition of the Chemical Building (Structure 300) and related items as indicated in the Drawings and in the Specifications as specified in SECTION 21 11 00—Water-Based Fire Protection, Section 22 30 00—Plumbing Equipment, Section 46 33 42—Chemical Phosphorus Removal Equipment and Section 43 41 45—Fiberglass Reinforced Plastic Chemical Tanks. B ID ALTERNATIVE NO. 3: CONTRACTOR shall include in the cost of the Bid Alternative ALL work associated with providing the scope listed below. The price of $ (31i -I ,oOO . 00 shall be deducted from the Contract Lump Sum Base Bid if CITY elects to have CONTRACTOR eliminate the addition of Primary Sludge Pumps (P-3-15-1 and P-3-15-2) and associated piping, modifications to existing WAS Well No. 2 and No. 3 and related items in the WAS Building (Structure 170) as indicated in the Drawings and in the Specifications as specified in S ection 1334 23.25—FRP Flat Panel Cover System and Section 43 23 57—Progressing Cavity Pumps. B ID ALTERNATIVE NO. 4: CONTRACTOR shall include in the cost of the Bid Alternative ALL work associated with providing the scope listed below. The price of $(Q.L61000 .06) shall be deducted from the Contract Lump Sum Base Bid if CITY elects to NTRACTOeliminate the replacement of Boilers No. 1 and No. 3(Mn11 24 1 and M-11-24-3 , have CO p ( ) recirculation pumps (P-11-31-1 and P-11-31-2), associated piping modifications and related items in the D igester Control Building (Structure 310) as indicated in the Drawings and in the Specifications as specified in Section 23 21 16—Hydronic Piping Specialties, Section 23 21 23 Hydronic Pumps, S ection 23 25 00—HVAC Water Treatment, and Section 23 52 39—Fire Tube Boilers. FORM OF BID Section BF -2 4463.004/City Contract No. 994 3. Equipment Alternatives The name of the Base Bid equipment manufacturer which Bidder shall include in the Lump Sum Base Bid is listed for each equipment item. Where an alternative manufacturer is listed, Bidder shall include an add or deduct to the price of the equipment that Bidder included in the Lump Sum Base Bid. Where spaces are provided, Bidder may also bid other alternative manufacturers by writing in the alternative manufacturer's name Equipment Alternative Bid prices shall include the entire cost of the Alternative, including cost for engineering changes to accommodate the Alternative, and additional work to be performed which is not shown on the Drawings, but which is required as a result of selection of the Alternative. Whether or not an alternative manufacturer is offered to one or more of the Base Bid equipment manufacturers provided for in the Bid Form, Bidder shall write (in numbers) the price for providing the Base Bid equipment manufacturer, as included in the Lump Sum Base Bid. When more than one Base Bid equipment manufacturer name is listed for an item, Bidder shall circle the name of the equipment manufacturer selected for the Lump Sum Base Bid and write in the price for the selected equipment. FORM OF BID Section BF -3 4463.004/City Contract No. 994 EQUIPMENT ALTERNATIVES FORM OF BID Revised Section BF -4 4463.004/City Contract No. 994 (Addendum No. 1) Item Equipment Base Bid Manufacturer Included in the Lump Sum Base Bid (Circle One) Cost of Equipment Included in the Lump Sum Base Bid Alternative Manufacturer Add to Base Bid for Alternative Manufacturer Deduct From Base Bid for Alternative Manufacturer A. Fire Tube Boilers (Section 23 52 39) _ Burnham $ 1 OC 000 • 0 O r (+) (-) (+) (-2 B SCADA System Supplier (Section26 09 00) CAutomati.strns- OR Integrated Process Solutions OR Wunderlich-Malec �1 OC�O C. Shaftless Screw Conveyors 4112 13) Custom Conveyor( Corporation OR O®(+)(Section +2 (+) (-) DV Equipment Spirac Conveying Technology D. . Tri -Lobe Positive Displacement Blowers (Section 43 11 33) tsercomPressors$ Inc. ___ _�______ __ Aerzen USA(+l $ 2.An 0� . 00 (+) (-) (-) . E. Progressing Cavity Pumps 43 23 57) Seepex $ 5LQcxO.00 (+)(Section (+) (-) F. Submersible Pumps (Section 43 25 i 0 ) Flygt $ 10l �QO • C� O (+) (-) (±) (-) G. Macerators (Section 46 24 13) Boerger $OIG 1 OW sae (+) (-) (+) (-) FORM OF BID Revised Section BF -4 4463.004/City Contract No. 994 (Addendum No. 1) FORM OF BID Revised Section BF -5 4463.004/City Contract No. 994 (Addendum No. 1) Item Equipment Base Bid Manufacturer Included in the Lurnp Sum Base Bid _ (Circle One) Cost of Equipment Included in the Lump Sum Base Bid Alternative Manufacturer Add to Base Bid for Alternative Manufacturer Deduct From Base Bid for Alternative Manufacturer H. Polymer Feed Equipment (Section 46 33 33) VeloDyne UGSI --Fluid R Chemical Feed, Inc. Dynamics $ 60(000. ©o (+) (-) (4-) (-) Chemical Phosphorus Removal Equipment (Section 46 33 42) rS1ui htte , $ 15 000. 00 / ( (+) (-) OR Prominent J. Submersible Mixers (Section 46 41 23) Flygt $ %00 000 • co / (+) (-) (+) (-) K. Coarse Bubble Diffusers (Section 46 51 21) Sanitaire-Xylem $ / 00l 000. 00 (+) (e) (+) (-) L. Dewatering Centrifuge Equipment (Section 46 76 33) Centrisys, Inc, $ LI00 COO • CO J (+) (-) (+) (-) FORM OF BID Revised Section BF -5 4463.004/City Contract No. 994 (Addendum No. 1) Item Number Description Estimated Quantity Included in the Lump Sum Base Bid Unit Bid Unit Price Total Bid Price Included in the Lump Sum Base Bid 1. Concrete Surface Repair -Top of Wall Repairs Section 03 01 30 10 CF $ /90.0o $ cl t l CO00 2 Concrete Surface Repair -Wall Vertical Surface and Underside of Slab Repairs/ Section 03 01 30 10 CF $ )1100.00 $ 1 j 000.00 $ cli apo. ap 3. Concrete Surface Repair -Top of Slab Repairs Section 03 01 30 10 CF $ 6100 .00 4. Masonry Restoration and Cleaning -100% Repointing Section 04 01 20 8,000 SF $ 2.0 .00 $ foo WO . CO 1 5. Masonry Restoration and Cleaning- <100% Repointing Section 04 01 20 1,000 LF $ Li • OQ $ LAI 000 QV 6. Brick Replacement Section 04 01 20 250 SF $ 'RW .oQ $ t31 SOO ' 0 7. Excavation, Backfill, and Grading- Unsuitable Foundation Material for Structures Section 31 23 00 1,500 CY $ 16 .00 $ I q t ooC , 00 8. Excavation, Backfill, and Grading- Unsuitable Foundation Material for Utility Trenches Section 31 23 00 500 CY $ '�o $ 221 WOO • 00 4. Cash Allowances The following Cash Allowances shall be included in the Lump Sum Base Bid. The Cash Allowances for non Lump Sum items shall be equal to the product of the quantity included in the Lump Sum Base Bid and the Unit Price. The Cash Allowances will be adjusted in the event that estimated quantities to be included in the Lump Sum Base Bid are different from final measured quantities. A single Unit Price shall be bid for each item. Failure to include one or more of the following Unit Price items may result in rejection of the entire Bid as nonconforming. For items with a quantity of 1, the Cash Allowance shall be adjusted based on actual final costs. CASH ALLOWANCES FORM OF BID Section BF -6 4463.004/City Contract No. 994 5. 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. 6. Security in the sum of Dollars ($ N/A ) in the form of Bid Bond is submitted herewith in accordance with the INSTRUCTIONS TO BIDDERS 5% of bid 7. Attached hereto is a Non -Collusion Affidavit of Prime Contractor. 8. Attached hereto is a Resident Bidder Certification ( X ), or Non -Resident Bidder Certification ( ). (Mark one.) 9. The Bidder is prepared to submit a financial and experience statement upon request. 10. 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. 11. The Bidder has received the following Addendum or Addenda: Addendum No. 1 Date January 10, 2020 January 17, 2020 la4iimarts, ail aOQa 12. 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. 13. The Bidder has filled in all blanks on this proposal. Those blanks not applicable are marked "none" or "NA". 14. The Bidder has attached all applicable forms. 15. CITY 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. FORM OF BID Section BF -7 4463.004/City Contract No. 994 Woodruff Construction, LLC January 23, 2020 BY: Do (Name of Bidder) (Date) ald A. Woodruff Title President Official Address: (Including Zip Code): 1890 Country Lane Fort Dodge, IA 50501 I.R.S No. 76-=0721180 END OF SECTION FORM OF BID Section BF -8 4463.004/City Contract No. 994 Bidder Status Form To be completed by all bidders Please answer "Yes" or "No" for each of the following: L rg Part A Yes El 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 D No My company has an office to transact business in Iowa. Yes No My company's office in Iowa is suitable for more than receiving mail, telephone calls, and e-mail. Yes R No 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. Yes 9 No To be completed by resident bidders My company has maintained offices in Iowa during the past 3 years at the following addresses: Part B Dates: 8 / 1 4990 to PRES1NT / Address) -89° Kountry Lane City, State, Zip- Fort Dodge, IA 50501 Dates: 5 / 25 /1996 to PRESENT j Address: 1920 Philadelphia St., Ste. 102 City, State, Zip: Ames, IA 50010 Dates: 2 8 /2 016 to PRESENT Address: 501 Greenfield Drive You may attach additional sheets) if needed. City, State, Zip: Tiffin, IA 52340 To be completed by non-resident bidders PartC 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? U Yes No pr f type 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: Woodruff Construction, LLC Signature: -- Date: January 23, 2020 Dona '• A. Woo • ruff, President 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, RB -1 4463.004/City Contract No. 994 Additional Sheet for Bidder Status Form (continued) My company has maintained offices in Iowa during the past 3 years at the following addresses: Dates: 7 / 17 / 2017 to Present/ / Address Dates: 5 / 1 / 2014 to 7 / 14 / 2017 1717 Falls Avenue City, State, Zip* Waterloo, IA 50701 Address 505West 4th Street City, State, Zip; Waterloo, IA 50701 Worksheet: Authorization to Transact Business This worksheet may be used to help complete Part A of the Resident Bidder Status form. If at least one of the following describes your business, you are authorized to transact business in Iowa Yes ❑ No My business is currently registered as a contractor with the Iowa Division of Labor, ❑ Yes D No My business is a sole proprietorship and 1 am an Iowa resident for Iowa income tax purposes. ❑ Yes ❑ No My business is a general partnership or joint venture. More than 50 percent of the general partners or joint venture parties are residents of Iowa for Iowa income tax purposes. ❑ 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 reportand has not filed articles of dissolution Yes D No My business is a corporation whose articles of incorporation are filed in a state other than Iowa, the corporation has received a certificate of authority from the Iowa secretary of state has filed its most recent biennial report with the secretary of state, and has neither received a certificate of withdrawal from the secretary of state nor had its authority revoked. ❑ Yes ■ No My business is a limited liability partnership;; ich has f.ted a statement of girali cation in th' tate and the statement has not been carte ■ ■ 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 ❑ No My business is a limited partnership or limrted liability limited partnership which has filed a cerkfieate of limited partnership in this state,and has not filed a statement of termination. Yes ■ No ❑ Yes ■ nes d padders ted ina irship has recei e uthcirrty has bee ted parinershiip whose ce partnership or etary of state t My t3usirsess is p not filed a statement of termination: e li a My business a limited liati1 than Iowa, has received a certificate d has not been revoked or canceled_ ffi hip. bon'ti e of RB -2 4463.004/City Contract No. 994 insact burin in low a NON -COLLUSION AFFIDAVIT OF PRIME BIDDER State of Iowa County of Webster that: )ss Donald A. Woodruff , being first duly sworn, deposes and says 1. He is Owrier (Owner, Partner, Officer, Representative, or Agent) , of Woodruff Constructjthtne Bidder that has submitted the attached Bid; LLC 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, representives, owners, employees, or parties in interest, including this affiant. (Signed) Do President 00 r Title Subscribed and sworn to before me this 23rd day of January , 20 2Q My commission expires 1-24=202 3- .cPcom-,s‘ MMJARGAFIET ROGEIRS 2 Commission Number 782324 ' My Commission Expires eAdzit NON -COLLUSION AFFIDAVIT Section NCA -1 4463.004/City Contract No. 994 MBE/WBE BUSINESS ENTERPRISE PRE-BID CONTACT INFORMATION FORM P rime Contractor Name: Woodruff Construction LLC Project:2 02 0 Wastewater Letting Date1 —2 3— 2 0 2 0 N O 9ViE/WBE SUBCONTRACTORS: If y&aarflsi Ein AMOMaa(26) a brTef explanation as to why subcontracting wa trot feasible with this project. If any MBE/WBE subcontractors will be used, please use the bottom portion of this form. Contractor Signature: / �_ _ Title: President Date: 1-23-2020 Do � d A. Woodruff S L13CONTR CTORS 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 MBEIWBE Business Enterprise contacts made prior to your bid submission. This information is subject to verifications and confirmation. If you are unable to identify MBE/WBE firms to perform portions of the work, please contact Louis Starks, Contract Compliance Officer, for assistance at (319) 291-4429. In the event it is determined that the MBE/WBE Business Enterprise goals are not met, then before awarding the contract the City of Waterloo will make a determination as to whether or not the apparent successful low bidder made good faith efforts to meet the goals. TABLE OF INFORMATION SHOWING BIDDER'S PRE-BID MBE/WBE BUSINESS ENTERPRISE CONTACTS PRE -CID CONTACT INFORMATION FORM (Form CCO-4) Rev. 06-20-02 Section M-6 4463.004/City Contract No. 994 quotes Received Quotation used in bid M 1::E/W IE Dates Dates Dollar Amount Proposed to Subcontractors Contacted Yes/No Contacted Yes/No s/No be Subcontracted Oat� �o‘Za ° N JA- i hip.°b0,941.3.2A-ULckAALc No f I I qi Di 7..0 1A - -)1 ,C , bytperbectucriA- A litAte � o N IA JA2.teJvC,b)-1,060a2,, '�'���e t1k PRE -CID CONTACT INFORMATION FORM (Form CCO-4) Rev. 06-20-02 Section M-6 4463.004/City Contract No. 994 SactfrifnA• fit -co Ceittkawa Wo-oc9AAlt MBE/WBE BUSINESS E TERPRISE PRE -BIB CONTACT INFORMATION FORM Prime Contractor Name: tett Project: �0�f Letting Date: I 2.4\202-0 natAi (P1,ee- Bi oso U c3 t ,ccct, ca H1m39 a & v a a4tV ( (A -- NO MBE/WBE S:JBCONTRAC a ORS: 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: Title: Date: 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 veriftcattons 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 SLIDER'S PRE-BID :w BE/ =� E L SINESS ENTERPRISE CONTACTS Quotes deceived Quotation used in bid Sankneent-u-actors \ i tE/WEE Dates Contacted Yes/No Dates Contacted Yes/!o Dollar Amount Proposed to be Subcontracted a v1/44addiuOnstmitaCervtN thol2-6 Nik AtieLb4;1co • (10120 Nit AD atter eartatutzdtin4 1 tio(W fb AO PRE-BID CONTACT INFORMATION FORM (Form CCO-4) Rev. 06-20-02 Section M-6 4463.004/City Contract No. 994 LETTER TO BE USED WHEN SOLICITING FOR SUBCONTRACTOR QUOTES CARTER ELECTRIC 725 ADAMS STREET WATERLOO, IA 50703 JANUARY 10, 2020 City of Waterloo Contract No. 994 RE: Contract No.: Waterloo Wastewater Treatment Plant Biosolids Modifications Dear Mr. Derrick Carter • Woodruff Construction, LLC is presently soliciting for the following work in connection with the above referenced project. P lease review the Plans and Specs for Division 26 Scope of Work. H ard Copy Sets are available at Waterloo City Hall, or online at https://app.isgft.com/#/proiect/cur3895370 Woodruff Construction, LLC is an Equal Opportunity Employer, and all qualified bidders will not be discriminated against due to race, religion, color, sex or origin. If interested in bidding your proposal must be turned in to this office by January 22, 2020 and (Date) Sincerely, Brandy Luna AdminisLraLive AssisLanL 2 00 PM (Time) SUBCONTRACTOR QUOTES Section M-3 Form CCO- 3 (11/28/2001) 4463.004/City Contract No. 994 LETTER TO BE USED WHEN SOLICITING FOR SUBCONTRACTOR QUOTES CULPEPPER ELECTRIC 1731 COTTAGE GROVE AVE. WATERLOO, IA 50707 JANUARY 10, 2020 City of Waterloo Contract No. 994 RE: Contract No.: Waterloo Wastewater Treatment Plant Biosolids Modifications D ear Mr. Martin Culpepper : Woodruff Construction, LLC is presently soliciting for the following work in connection with the above referenced project. P lease review the Plans and Specs for Division 26 Scope of Work. H ard Copy Sets are available at Waterloo City Hall, or online at https://app.isgft.com/t;/project/cur3895370 Woodruff Construction, LLC is an Equal Opportunity Employer, and all qualified bidders will not be discriminated against due to race, religion, color, sex or origin. If interested in bidding your proposal must be turned in to this office by January 22, 2020 and 2 00 PM (Date) (Time) S incerely, Brandy Luna Administrative Assistant S UBCONTRACTOR QUOTES Section M-3 Form COO- 3 (11/28/2001) 4463.004/City Contract No. 994 LETTER TO BE USED WHEN SOLICITING FOR SUBCONTRACTOR QUOTES DANIELS HOME IMPROVEMENT 339 ALBANY STREET WATERLOO, IA 50703 JANUARY 10, 2020 City of Waterloo ConLract No. 994 RE: Contract No.: Waterloo Wastewater Treatment Plant Biosolids Modifications D ear Mr. Sammy Daniels • Woodruff_ Construction, LLC is presently soliciting for the following work in connection with the above referenced project. Please review the Plans and Specs for Division 03 Scope of Work. Hard Copy Sets are available at Waterloo City Hall, or online at https://app.isgft.com/#/project/cur3895370 Woodruff Construction, LLC is an Equal Opportunity Employer, and all qualified bidders will not be discriminated against due to race, religion, color, sex or origin. If interested in bidding your proposal must be turned in to this office by January 22, 2020 and 2:00 PPI (Time) (Date) S incerely, Brandy Luna Administrative Assistant S UBCONTRACTOR QUOTES Section M-3 Form CCO- 3 (11/28/2001) 4463.004/City Contract No. 994 D . C. CORPORATION 426 BEECH STREET WATERLOO, IA 50703 LETTER TO BE USED WHEN SOLICITING FOR SUBCONTRACTOR QUOTES JANUARY 10, 2020 City of Waterloo Contract No. 994 RE: Contract No.: Waterloo Wastewater Treatment Plant Biosolids Modifications Dear Mr. Terry Phillips woodruff Construction, LLC is presently soliciting for the following work in connection with the above referenced project. Please review the Plans and Specs for Division 03 Scope of Work. H ard Copy Sets are available at Waterloo City Hall, or online at h ttps://app.isgft.com/#/project/cur3895370 W oodruff Construction, LLC is an Equal Opportunity Employer, and all qualified bidders will not be discriminated against due to race, religion, color, sex or origin. If interested in bidding your proposal must be turned in to this office by January 22, 2020 and 2:00 PM (Date) Sincerely, B randy Luna Administrative Assistant (Time) • SUBCONTRACTOR QUOTES Section M-3 Form COO- 3 (11/28/2001) 4463.004/City Contract No. 994 LETTER TO BE USED WHEN SOLICITING FOR SUBCONTRACTOR QUOTES GREER'S WORKS 2003 PLAINVIEW STREET W ATERLOO, IA 50703 JANUARY 13, 2020 City of Waterloo ConLracL No. 994 RE: Contract No.: Waterloo Wastewater Treatment Plant Biosola.ds Modifa.cattons D ear Mr. Willie Greer • • woodruff Construction, LLC is presently soliciting for the following work in connection with the above referenced project. P lease review the Plans and Specs for Division 03 Scope of Work. Hard Copy Sets are available at Waterloo City Fall, or online at h ttps://app.isgft.com/#/project/cur3895370 W oodruff Construction, LLC is an Equal Opportunity Employer, and all qualified bidders will n ot be discriminated against due to race, religion, color, sex or origin. If interested in bidding your proposal must be turned in to this office by January 22, 2020 and (Date) S incerely, B randy Luna Administrative Assistant 2:03 PM (Time) S UBCONTRACTOR QUOTES Section M-3 Form CCO- 3 (11/28/2001) 4463.004/City Contract No. 994 QUICK CONSTRUCTION 217 BATES STREET WATERLOO, TA 50703 LETTER TO BE USED WHEN SOLICITING FOR SUBCONTRACTOR QUOTES JANUARY 10, 2020 City of Waterloo Contract No. 994 RE: Contract No.: Waterloo Wastewater Treatment Plant Biosolids Modifications Dear Mr. Leroy Harrington : Woodruff Construction, LLC is presently soliciting for the follow rig work in connection with the above referenced project. P lease review the Plans and Specs for Division 03 Scope of Work. H ard Copy Sets are available at Waterloo City Hall, or online at https://app.sgft.com/#/project/cur3895370 Woodruff Construction, LLC is an Equal Opportunity Employer, and all qualified bidders will not be discriminated against due to race, religion, color, sex or origin. If interested in bidding your proposal must be turned in to this office by January 22, 2020 and 2:00 PM (Date) Sincerely, Brandy Luna Administrative Assistant (Time) • SUBCONTRACTOR QUOTES Section M-3 Form COO- 3 (11/28/2001) 4463.004/City Contract No. 994 LETTER TO BE USED WHEN SOLICITING FOR SUBCONTRACTOR QUOTES ATLAS PAINTING, INC. 911 SYCAMORE STREET PO BOX 65 WATERLOO, IA 50704 City of Waterloo ContracL No. 994 RE: Contract No.: Waterloo Wastewater Treatment Plant Biosolids Modifications JANUARY 10, 2020 D ear Alas Painting, Inc. : w oodruff Construction, LLC is presently soliciting for the following work in connection with the above referenced project. P lease review the Plans and Specs for Division 09 Scope of Work. H ard Copy SeLs are available at Waterloo City Hall, or online at https://app.isgft.com/#/project/cur3895370 W oodruff Construction, LLC is an Equal Opportunity Employer, and all qualified bidders will n ot be discriminated against due to race, religion, color, sex or origin. If interested in bidding your proposal must be turned in to this office by January 22, 2020 and 2:00 PM (Date) (Time) S incerely, (-koLikeN cPyucAuv B randy Luna Administrative Assistant S UBCONTRACTOR QUOTES Section M-3 Form CCO - 3 (11/28/2001) 4463.004/City Contract No. 994 LETTER TO BE USED WHEN SOLICITING FOR SUBCONTRACTOR QUOTES WATCO CONSTRUCTION, INC. 2920 TEXAS STREET W ATERLOO, IA 50702 JANUARY 10, 2020 City of Waterloo ConLracL No. 994 RE: Contract No.: Waterloo Wastewater Treatment Plant Biosoltds Modif±catlons Dear Ms. Patricia Kimball : Woodruff Construction, LLC is presently soliciting for the following work in connection with the above referenced project. P lease review the Plans and Specs for Divisions 31--33 Scope of. Work. H ard Copy Sets are available at Waterloo City Hall, or online at h ttps://app.isgft.com/#/project/cur3895370 W oodruff Construction, LLC is an Equal Opportunity Employer, and all qualified bidders will n ot be discriminated against due to race, religion, color, sex or origin. If interested in bidding your proposal must be turned in to this office by January 22, 2020 and (Date) Sincerely, Brandy Luna Administrative Assistant 2:00 PM (Time) • SUBCONTRACTOR QUOTES Section M-3 Form COO- 3 (11/28/2001) 4463.004/City Contract No. 994 EQUAL OPPORTUNITY CLAUSE (As provided in Executive Order No. 11246) All contractors, subcontractors, vendors and suppliers of goods and services doing business with the City and value of said business equals or exceeds ten thousand dollars ($10,000.00) annually agree as follows: 1.. The contractors, subcontractor, vendor and supplier of goods and services will not discriminate against any employee or applicant for employment because of race, color, creed, sex, national origin, economic status, age, mental or physical handicap, political opinions or affiliations. The contractor, subcontractor, vendor and supplier will develop an Affirmative Action program to e nsure that applicants are employed and that employees are treated during employment without regard to their race, creed, color, sex, national origin, religion, economic status, age, mental or physical disability, political opinions or affiliations. Such actions shall include but not be limited to the following: a. Employment b. Upgrading c. Demotion or Transfer d. Recruitment and Advertising e. Layoff or Termination f Rates of Pay or Other Forms of Compensation g. Selection for Training Including Apprenticeship 2. The contractor, subcontractor, vendor and supplier of goods and services will, in all solicitations o r advertisements for employees, state that all qualified applicants will receive consideration for e mployment without regard to race, creed color, sex, national origin, religion, economic status, age, mental or physical disabilities, political opinion or affiliations. 3. The contractor, subcontractor, vendor and supplier or his/her collective bargaining representative will send to each labor union or representative of workers which he/she has a collective bargaining agreement or other contract or understanding a notice advising said labor u nion or workers' representative of the contractor's commitment under this section. The contractor, subcontractor, vendor and supplier of goods and services will comply with all published rules, regulations, directives, and order of the City of Waterloo Affirmative Action Program Contract Compliance Provisions. The contractor, subcontractor, vendor and supplier of goods and services will furnish and file compliance reports within such time and upon such forms as provided by the Affirmative Action Officer. Said forms will elicit information as to the policies, procedures patterns and practices of each subcontractor as well as the contractor himself/herself and said contractor, subcontractor, vendor and supplier will permit access to his/her employment books, records and accounts to the City's Affirmative Action Officer, for the purpose of investigation to ascertain compliance with this contract and with rules and regulations of the City's Affirmative Action Program—Contract Compliance Provisions relative to Resolution No. 24664. In the event of the contractor's non-compliance with the non-discrimination clauses of this contract or with any of such rules, regulations and orders, this contract may be canceled, terminated or suspended in whole or in part and the contractor may be declared ineligible for further contracts in accordance with procedures authorized by the City Council. EQUAL OPPORTUNITY CLAUSE Section EOC-1 4463.004/City Contract No. 994 7. The contractor, subcontractor, vendor and supplier of goods and services will include, or incorporate by reference, the provisions of the non-discrimination clause in every contract, subcontract or purchase order unless exempted by the rules, regulations or orders of the City's Affirmative Action Program, and will provide in every subcontract, or purchase order that said provisions will be binding upon each contractor, subcontractor, or supplier. 8. We, the undersigned, recognize that we are morally and legally committed to non-discrimination in employment. Any person who applies for employment with our company will not be discriminated against because of race, creed, color, sex, national origin, economic status, age, mental or physical disabilities. (Signed) ( (- {oropriate Off tial DollaA. Waadrut f President (Title) January 23, 2020 (Date) END OF SECTION EQUAL OPPORTUNITY CLAUSE Section EOC-2 4463.004/City Contract No. 994 SRF Requiared Front End Specifications This packet includes the special requirements that apply only to projects subject to "American Iron and Steel" requirements enacted by Congress on January 17, 2014. Please consult with the DNR Project Manager to determine if the AIS requirements apply. If not, Attachment 9 may be removed. 'Attachment 1:.) Certification of Non -Segregated Facilities Form (to be completed and signed by Prime Contractor and submitted with the bid) Attachment 2: Statement in Advertisement for Bids on Debarment and Suspension/Certification Regarding Debarment and Suspension Form (to be completed and signed by Prime Contractor and submitted with the bid) ( Attachment 3:tia CAttachment 4: ,) Attachment 5: Attachment 6: Attachment 7: Attachment 8: Attachment 9: Please note: Disadvantaged Business Enterprise Certification Form (to be completed and signed by Prime Contractor and submitted with the bid) DBE Program Subcontractor Performance Form (to be completed and signed by Prime and DBE Subcontractor for each subcontract and submitted with the bid) DBE Program Subcontractor Utilization Form (to be completed and signed by Prime Contractor and submitted with the bid) DBE Program Subcontractor Participation Form (for voluntary use of DBEs) Other Federal Requirements Language A. Standard Equal Employment Opportunity Specifications B . Federal Labor Standards Provisions (including Davis -Bacon prevailing wage rates) C. Preservation of Open Competition and Government Neutrality D . Historical and Archeological Finds E . Prohibitions on Procurement from Violating Facilities Right of Entry and Records Retention Use of American Iron and Steel The Davis Bacon wage determination received from the Iowa Finance Authority must also be included in the front-end specifications. STATE REVOLVING FUND Section SRF -1 4463.004/City Contract No. 994 Attachment 1 SRF Required Front -End Specifications (This forrn must be completed and signed by Prime Contractor and submitted with the bid.) U.S Environmental Protection Agency Certification of Non -Segregated Facilities (Applicable to contracts, subcontracts, and agreements with applicants who are themselves performing Federally assisted construction contracts, exceeding $10,000 which are not exempt from the provisions of the Equal Opportunity clause.) By the submission of this bid, the bidder, offeror, applicant, or subcontractor certifies that he does not maintain or provide for his employees any segregated facilities at any of his establishments, and that he does not permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. He certifies further that he will not maintain or provide for his employees any segregated facilities at any of his establishments, and that he will not permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. The bidder, offeror, applicant, or subcontractor agrees that a breach of this certification is a violation of the Equal Opportunity clause in this contract. As used in this certification, the term "segregated facilities" means any waiting rooms, work areas, restrooms and washrooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking Tots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, creed, color, or national original, because of habit, local custom, or otherwise. He further agrees that (except where he has obtained identical certifications from proposed subcontractors for specific time periods) he will obtain identical certifications from proposed subcontractors prior to the award of subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Opportunity clause; that he will retain such certifications in his files; and that he will forward the following notice to such proposed subcontractors (except where the proposed subcontractors have submitted identical certifications for specific time periods): NOTICE TO PROSPECTIVE SUBCONTRACTORS OF REQUIREMENT FOR CERTIFICATIONS OF NON -SEGREGATED FACILITIES A Certification of Non -segregated Facilities, as required by the May 9, 1967, order (33 F.R. 7808, May 28, 1968) on Elimination of Segregated Facilities, by the Secretary of Labor, must be submitted prior to the award of a subcontract exceeding $10,000 which is not exempt from the provisions of the Equal Opportunity clause. The certification may be submitted either for each subco ract or for all subcontracts during a period (i.e., quarterly, semiannually, or annually). January 23, 2020 S ignature, = Date Donald A. Woodruff, President 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 STATE REVOLVING FUND Section SRF -2 4463.004/CIty Contract No. 994 Attachment 2 SRF Required Frrontntnd Specifications (This form must be completed and signed by the Primo Contractor and submitted with the bid.) Debarments and Suspensions Any bidder or equipment supplier whose firm or affiliate is listed in on the U.S. General Services Administration Excluded Parties List System web site at http://www.epls.gov; will be prohibited from the bidding process. Anyone submitting a bid who is listed on this web site will be determined to be a non-responsive bidder in accordance with 40 CFR Part 31. United States Environmental Protection Agency Washington, DC 20460 Certification Regarding Debarment, Suspension, and Other Responsibility Matters The prospective participant certifies to the best of its knowledge and belief that it and the principals: (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; (b) Have not within a three year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission o f fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction: violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (c) Are not presently indicted for otherwise criminally or civilly charged by a government entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification; and (d) Have not within a three-year period preceding this application/proposal had one or more public transaction s (Federal, State, or local) terminated or cause or default. 1 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. Donald A. Woodruff, President Typed Name & Title of Authorized Representative January 23, 2 02 0 Signa of Authorized Representative Date 1 am unable to certify to the above statements. My explanation is attached. EPA Form 5700-49 (11-88) STATE REVOLVING FUND Section SRF -3 4463.004/City Contract No. 994 Attachment 3 SRF Required Front -End Specifications (This form must be completed and signed by Prime Contractor and submitted with the bid.) Disadvantaged Business Enterprise (DBE) Solicitation It is EPA's policy that recipients of EPA financial assistance through the State Revolving Fund programs award a "fair share" of subagreements to small, minority and women -owned businesses, collectively know as Disadvantaged Business Enterprises (DBEs). Iowa's Fair Share goals are: Only work performed by certified DBEs can be counted toward the goals. In Iowa, DBEs must be certified through the Iowa Department of Transportation (IDOT). Information on certification requirements and a list of certified DBEs is. on the IDOT website at blip.%! YR1%�:��t'lY.iowadoi.go�:: contractsjconiiacts 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 (MBF) Goal Women -Owned Business M Enterprise (WBE) Goal Construction 1.7% 2.2% Supplies 0.6% 5.6% Services 2 5% 11.3% Goods/Equipment 2 5% 10.4% Avera Ie 515. 6.1118 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 blip.%! YR1%�:��t'lY.iowadoi.go�:: contractsjconiiacts 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: Woodruff Construction, LLC Address: 1890 Kountry Lane , Fort Dodge, IA 50501 Contact Person: 1 Donald A'CWooclru ff r Signature: Phone Number: 515. 6.1118 E -Mail Address: donor@woodruff . build Check if Prime Contractor is: 0 Minority -Owned ❑ Women -Owned STATE REVOLVING FUND Section SRF -4 4463.004/City Contract No. 994 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? [4 Yes Lai No 2. Did you make information on forthcoming opportunities available to DBEs and arrange time frames for contracts and establish delivery schedules, where the requirements permit, in a way that encourages and facilitates participation by DBEs in the competitive process? This includes, whenever possible, posting solicitation for bids or proposals for a minimum of 30 calendar days before the bid or proposal closing date. E Yes Fi No 3. Did you consider in the contracting process whether firms competing for Targe contracts could subcontract with DBEs? This will include dividing total requirements, when economically feasible, into smaller tasks or quantities to permit maximum participation by DBEs in the competitive process. Ix' 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? E Yes Li 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 E No 6. List the potential DBE subcontractors that were contacted. Only list those that are certified through the Iowa Department of Transportation. Name eat EQ•ealc, How Contacted (e.g. letter, phone call, fax, e-mail) A4ww4. cbabA tiL tbaNI. Atrzve-&wt 1) it C644zixei4 Mikevet altiotteak, (Atm- Response (e.g. did not respond, not interested, not competitive) 4ttri,t, ?Lint atdx,tp revuttactitRA 4sebbvt, Tid ho4- roseoitd oat- re-sQo vz d Vick. v1.0 Y\42-Scron01 icmt IvAtm, Diol vt.ot resea ►ted %NA l/to ,neSr) ►� Dick vwt respoviol C OUTI Nugb ON NEXT PA -6. • • PROPOSED UTILIZATION OF DBE SUBCONTRACTORS Please include Attachments 4 and 5 to document the proposed utilization of certified DBE subcontractors. STATE REVOLVING FUND Section SRF -5 4463.004/City Contract No. 994 CONTRACT ADMMINIS T RAT ION PROVISIONS Several contract provisions are required to prevent unfair practices that adversely affect DBEs. These include: 1. Prime Contractor must pay its Subcontractor for satisfactory performance no more than 30 days from the Prime Contractor's receipt of payment from the SRF loan recipient. 2. Prime Contractor must notify the SRF loan recipient in writing prior to termination of a DBE subcontractor for convenience. 3. Prime Contractor must employ the six Good Faith Efforts to solicit a replacement subcontractor if a DBE subcontractor fails to complete work under a subcontract for any reason. Qme, 411-424 Pacmituvt, akes-O Centioauctem coupNu-6D 'fowl premiou s 4946E STATE REVOLVING FUND Section SRF -6 4463.004/City Contract No. 994 R-a5fon 1>tA ‘A.40 + Yresipon-w'1 toiNck im k 2�seod $ Attachment 4 SRF Required Fronts End Specifications (This form must be completed and signed by Prime and DBE Subcontractor for each subcontract and submitted with the bid.) OMB Control No: 2090-0030 Approved 8/13/2013 Approval Expires 8/31/2015 United States Environmental Protection Agency Disadvantaged Business Enterprise Program DBE Subcontractor Performance Form This form is intended to capture the DBE1 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. '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, fines, 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 STATE REVOLVING FUND Section SRF -7 4463.004/City Contract No. 994 Subcontractor Name Project Name r\J f Pi _ __ Bid/Proposal No. Assistance Agreement ID No. (if known) Point of Contact Address Telephone No. Email Address Prime Contractor Name Woodruff Construction, LLC 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 s re c Pi v -e4 _______ * IN\ v re ns -es DBE Certified by Other: . DOT SBA Meets/exceeds EPA certification standards? YES NO 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, fines, 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 STATE REVOLVING FUND Section SRF -7 4463.004/City Contract No. 994 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 Donald A ® Woodruff Title Date President January 23, 2020 Subcontractor Signature Print Name l _ a....... N Pr 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 STATE REVOLVING FUND Section SRF -8 4463.004/City Contract No. 994 Attachment 5 SRF Required Front=End Specifications (This form must be completed and signed by Prime Contractor and submitted with the bid if utilizing DBE subcontractors.) OMB Control No: 2090-0030 Approved 8/13/2013 Approval Expires 8/31/2015 United States Environmental Protection Agency Disadvantaged Business Enterprise Program DBE Subcontractor Utilization Form This form is intended to capture the prime contractor's actual and/or intended use of identified certified DBE1 subcontractors2 and the estimated dollar amount of each subcontract. An EPA Financial Assistance Agreement Recipient must require its prime contractors to complete this form and include it in the bid or proposal package. Prince 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. 'Subcontractor is defined as a company, firm, joint venture, or individual who enters into an agreement with a contractor to provide services pursuant to an EPA award of financial assistance. EPA Form 61004. (DBE Subcontractor Utilization Form) - Page 1 STATE REVOLVING FUND Section SRF -9 4463.004/City Contract No. 994 t Iowa d Prime Contractor Name Woodruff Construction, LLC Project Naimp F . Y •. 2 02 0 Modifioa No. 994, wastewater C ®f Treatme�_ tons, City waterloo, Plant losolids Constract Assistance Agreement ID No. (if known) 50501 Point of Contact N a-ke G oo s an eskcOaess-s--61-n,c 1 . Bid/Proposal No. Address 1890 Kountry Lane, Fort Dodge, IA Telephone No. 515.576.1118 Email Address donw@woodruff.build Issuing/Funding Entity have identified potential DBE certified subcontractors please comaete the table below. If no, please explain: YES - . ` 4 NO Estimated Dollar Amount Currently DBE Certified? _tics. Subcontractor Name/Company Name Company Address/Phone/Email .9849) -ES eakitek-e4k -yts kkreArNQ So l i C i brA-- 0- 1 Yom f 0-Q- 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. 'Subcontractor is defined as a company, firm, joint venture, or individual who enters into an agreement with a contractor to provide services pursuant to an EPA award of financial assistance. EPA Form 61004. (DBE Subcontractor Utilization Form) - Page 1 STATE REVOLVING FUND Section SRF -9 4463.004/City Contract No. 994 t Iowa d 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 Title Print Name Donald A. Woodruff Date President January 23, 2020 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 STATE REVOLVING FUND Section SRF -10 4463.004/City Contract No. 994