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FORM OF
ID OR PROPOSAL
FY 2020 WATERLOO AIR AND RAIL PARK TREE CLEARING
CONTRACT NO 1017
CITY OF WATERLOO, IOWA
Honorable Mayor and City Council
Waterloo, Iowa
Gentlemen:
1. The undersigned, being a Corporation existing under the laws of the State of
o w n._ a Partnership consisting of the following partners:
OCAVi CI Moa +1 act. v- bus-h �n Ave.v is
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 FY 2020 WATERLOO AIR AND RAIL PARK TREE CLEARING
Contract No. 1017 all in accordance with the above -listed documents and for the
unit prices for work in place for the following items and quantities:
FY 2020
WATER_
00
AIR
AND
RAIL
PARK
TREE
C
_FARING
CONTRACT
NO.
1017
ITEM
BID:
DESCRIPTION
UNIT
EST. QTY.
UN
PRICE
TBID
TOTAL
BID
PRICE
1
MOBILIZATION
LS
1.0
®=
Lt--
$ 5000
$ SDOo
2
TREE
CLEARING
AC
18.7
$
$ 373.000
=`-
3
TRAFFIC
CONTROL
LS
1.0
'-
C.
$ 3
bO0
$ 3 O OO
TOTAL
BID
$ 3 8
3 coo
It is understood that the quantities set forth are approximate only and subject to
variation and that the unit bid price for the work done shall govern in the actual
payment to Contractor.
3. In submitting this bid, the bidder understands that the right is reserved by the City
of Waterloo, Iowa, to reject any or all bids. If written notice of the acceptance of
this bid is mailed, telegraphed, or delivered to the undersigned within thirty (30)
days after the opening thereof, or at any time thereafter before this bid is
withdrawn, the undersigned agrees to execute and deliver an agreement in the
prescribed form and furnish the required bond and certificate of the insurance
within ten (10) days after the agreement is presented to him for signature, and
start work within ten (10) days after "Notice to Proceed" is issued.
FORM OF BID
CONTRACT NO. 1017 Page 1 of 3
Security in the sum of fl i cct\ ` _ kovs o are. iiu+irl"eoi rfti � "9 0 e'
Dollars ($ 1 9 t SO ) in the form of Ce.,5L4.40.3 01Lk
is submitted herewith in accordance with the INSTRUCTIONS TO BIDDERS.
5. Attached hereto is a Non -Collusion Affidavit of Prime Contractor.
6. Attached hereto is a Resident Bidder Certification ( X ), or Non -Resident
Bidder Certification ( ). (Mark one.)
7 The bidder is prepared to submit a financial and experience statement upon
request.
The Prime Contractor and Subcontractor(s), which have performed an aggregate
of $10,000.00 in work for the City in the current calendar year, are prepared to
submit an AAP or Update and an EOC, within ten (10) days of notification that the
bid submitted is lowest and acceptable.
9. The bidder has received the following Addendum or Addenda:
Addendum No. 1 Date 2- M - 2 d
10. The bidder shall list the MBE/WBE subcontractor(s), amount of subcontracts and
bid items on the City of Waterloo Minority and/or Women Business Pre -bid
Contact Information Form. submitted with this Form of Bid or Proposal. The
apparent low Bidder shall submit a list of all other Subcontractor(s) to be used on
this Project to the City of Waterloo by 5:00 p.rn. the business day following the day
Bids on this Project are due along with .the Non -Collusion Affidavits of All
Subcontractor(s).
The Contractor shall submit information on subcontractors on
`SUBCONTRACTOR REQUEST AND APPROVAL" Form to be provided by City
prior to approval of contract.
The subcontractors listed on this proposal and/or submitted to the Contract
Compliance Officer cannot be changed except for the following reasons:
1) The City of Waterloo does not approve the subcontractors.
2) The subcontractors submit in writing that they cannot fulfill their
subcontracts.
11. The bidder has filled in all blanks on this proposal. Those blanks not applicable
are marked "none" or "NA".
12. The bidder has attached all applicable forms.
13. The Owner reserves the right to select alternates, delete line items, and/or to
reduce quantities prior to the award of a contract due to budgetary limitations.
FORM OF BID
CONTRACT NO. 1017 Page 2 of 3
BY:
(Date)
Title w\.�L�
Official Address: (Including Zip Code):
3768 Wc'd AtN l%.01/4.c 1-14)1
wcLestoo 1� CO703
I.R.S. No. 1A-1 LA 0.1V' b
(Name of Bidder)
FORM OF BID
CONTRACT NO. 1017 Page 3 of 3
KNOW ALL MEN BY THESE PRESENTS, that we,
as Principal, and
as Surety are held and firmly bound unto the CITY OF WATERLOO , Iowa, hereinafter called
"OWNER." In the penal sum
Dollars ($ ) 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 day of
, 20 , for
•
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 presents to be
signed by their proper officers this day of A D. 201 _
(Seal)
Principal
By
(Title)
(Seal)
Witness Surety
By
Witness Attorney in -fact
NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
State of I o %A c\
)ss
County of IJ tack-'-cw k )
0 u g'},r A, a v.&t 5 , being first duly sworn, deposes and says that:
1. He is (Owner,''artne', Officer, Representafve, or Agent) , of A tv.6i.5
�i�GaY���dti 1-• e Bidder that has submitted the attached Bid;
2. He is fully informed respecting the preparation and contents of the attached Bid and of all
pertinent circumstances respecting such Bid;
3. Such Bid is genuine and is not a collusive or sham Bid;
4. Neither the said Bidder nor any of its officers, partners, owners, agents, representatives,
employees, or parties in interest, including this affiant, has in any way colluded,
conspired, connived or agreed directly or indirectly, with any other Bidder, firm or person
to submit a collusive or sham Bid in connection with the Contract for which the attached
Bid has been submitted or to refrain frorn bidding in connection with such Contract, or
has in any manner, directly or indirectly, sought by agreement or collusion or
communication or conference with any other Bidder, firm or person to fix the price or
prices in the attached Bid or of any other Bidder or, to fix any overhead, profit or cost
element of the bid price or the bid price of any other Bidder, or to secure through any
collusion, conspiracy, connivance or unlawful agreement any advantage against the City
of Waterloo, Iowa, or any person interested in the Proposed Contract; and
5. The price or prices quoted in the attached Bid are fair and proper and are not tainted by
any collusion conspiracy, connivance or unlawful agreement on the part of the Bidder or
any of its agents, representatives, owners, employees, or parties in interest, including this
affiant.
(Signed)
✓4 a rn. 7Gt•
Title
Subscribed and sworn to before me this
t'� ( ,20n.
My commission expires 0- r 3 D 2?
•
day of
Title
JEN HUNTLEY
COMMISSION NO. 801014
• MYOOMMISSION EXPIRES
i �n-a
Budder Statm Form
To be completed by all bidders Part A
Please answer 'Yes" or `No' for each of the following:
54 Yes ❑ No My company is authorized to transact business in Iowa.
(To help you determine if your company is authorized, please review the worksheet on the next page).
Yes ❑ No My company has an office to transact business in Iowa.
Yes No My company's office in Iowa is suitable for more than receiving mail, telephone calls, and e-mail.
21 Yes ❑ No My company has been conducting business in Iowa for at least 3 years prior to the first request for
bids on this project.
14Z Yes ❑ No My company is not a subsidiary of another business entity or my company is a subsidiary of another
business entity that would qualify as a resident bidder in Iowa.
If you answered "Yes" for each question above, your company qualifies as a resident bidder. Please
complete Parts B and D of this form.
If you answered "No" to one or more questions above, your company is a nonresident bidder. Please
complete Parts C and D of this form.
To be completed by resident bidders
Part C
My company has maintained offices in Iowa during the past 3 years at the following addresses:
Dates: / / 1 l D 6 to Z/ 2? I 20 Address: "3 --1 6 8 W e- Si 4 ‘.. (t c Rw `t
City, State, Zip• w A "LG" I vo, ..- 4 10 ?03
Dates: / / to / / Address:
City, State, Zip:
Dates: / / to / / Address:
You may attach additional sheet(s) if needed. City, State, Zip:
To be completed by nonnresident bidders P rt C
1. Name of home state or foreign country reported to the Iowa Secretary of State:
2. Does your company's home state or foreign country offer preferences to resident bidders, resident labor
force preferences or any other type of preference to bidders or laborers? ,_, Yes U No
3. If you answered 'Yes' to question 2, identify each preference offered by your company's home state or foreign country
and the appropriate legal citation
You may attach additional sheet(s) if needed.
To be completed by all bidders
Part
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:
C tv�
Date: 2 - 2) — 2
You must submit the completed form to the governmental body requesting bids pe7 875 Iowa Administrative Code
Chapter 156. This form has been approved by the Iowa Labor Commissioner.
309-6001 (09-'15)
Worksheet: attkhorrazaf on to Transact r uskn e s
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 [iNo
Yes YIN o
2/Yes [[ No
r'es
Yes
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.
❑ No My business is an active corporation with the Iowa Secretary of State and has paid all fees
required by the Secretary of State, has filed its most recent biennial report and has not filed
articles of dissolution.
�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.
YesNo
n Yes o No
Yes[/No
❑ Yes ["No
[►'Yes D No
❑Yes ["No
My business is a limited liability partnership which has filed a statement of qualification in this
state and the statement has not been canceled.
My business is a limited liability partnership which has filed a statement of qualification in a
state other than Iowa, has filed a statement of foreign qualification in Iowa and a statement of
cancellation has not been filed.
My business is a limited partnership or limited liability limited partnership which has filed a
certificate of limited partnership in this state, and has riot filed a statement of termination.
My business is a limited partnership or a limited liability limited partnership whose certificate of
limited partnership is filed in a state other than Iowa, the limited partnership or limited liability
limited partnership has receive° 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)
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