HomeMy WebLinkAboutGranite Inlinerinliner.
76028 Forest
Boulevard N.-
Box 353
Hugo, MN
55038
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BID BOND
KNOW ALL MEN BY THESE PRESENTS, that we,
as Principal, and Travelers Vasua�� Q"" CITY OF WATERLOO Iowa, hereinafter called
as Surety are held and firmly bound unto the
Five Percent (5%) of Bid Amount
"OWNER." In the penal sum
of the United States, for the payment of which sum will and
Dollars ($ 5°/ of Bid Amount )
lawful money jointlyand
of this obligation is such that whereas the Principal has
be made, we bind ourselves, our heirs,execxecutors, administrators, and successors,
truly these presents. The con
severally, firmly by the accompanying bid dated the 3h day of A l
submitted Y , 9
for FY 2020 CIP PI ellnin Phase IVA
NOW, THEREFORE,
(a) If said Bid shall be rejected, or in the alternate,
ment of all
a contract in
(b) lu
If said Bid shall be accepted and the Principal malnceexecute
of saidand
con tact, and for the pal tres e s
specified and shall furnish a bond for his faithful pe or
s performing labor or furnishing materials in connection therewith, and shall in all of her
person p the acceptance of said Bid,
perform the agreement created by expressly
Surety for any and all claims hereunder shall, in no event,
this obligation shall be void, otherwise the same shall remain in force and effect; it being
Then d that the liability of the Y
understood and agreeunt of this obligation as herein stated.
exceed the penal amo
i al fails to execute the contract and provide
By virtue ofthe statutory authority, the full amount of this bid
i p bond shall be forfeited to the Owner in
nt
liquidation of damages she ained in the specifications or by laws
the bond as provided in the specifications and its
stipulates and agreeIs of the timthat the le within which igations of theuOwner may
The Surety, for value received, hereby p waive notice of any such
bond shall be in no way impaired or affected by any
accept such Bid or execute such contract; and said Surety does hereby
extensions
an
or orate seals to be hereto affixed and these
S WHEREOF, the Principal and the Surety, have hereunto set their hands 2� seals,
IN WITNES A.D. 20_ 0.
such of them as are corporations, have caused the day of A rilINN
ents to be signed by their proper officers this 2n _(S 1
t InIJ e LLC z
Granite
Witness
princip I
By (Title) Area Manager
Daniel J. Ban en (� )
grs Casualty and Sure
Surety !��
�, By
rrn
`,PNaasi suRF
Maria Gomez ,�ti, •..�A,
sQ
=a? HARTFORD,';�
CONN. o
N
CONTRACT NO. 10'1;4j' •. saa'
Company of America
n-fact Isabel Barron
Page BB-1 OF 1
FY 2020 CIP Pipelining Ph IVA
BID BOND
AECOM 60620183
A notary public or other officer completing this
certificate verifies only the identity of the individual AC KN OW LEDG M EN
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or validity
of that document.
State %J CaliSanta Cruz
County of
Maria Gomez, Notary Public
On April 2, 2020 before me, (insert name and title of the officer)
personally appeared Isabel Barron
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is are
subscribed to the within instrument and acknowledged hhis/her/their signature(s) hey executed the on the instrument the
in
his/her/their authorized capaclty(les), Y
person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct. MARIA GOMEZ
WITNESS my hand and official seal.
�"/
Signature
Maria Gomez, Notary Public
COMM. #2259567 �
Notary Public-Californiao
(Seal)
TRAVELERS
Travelers Casualty and Surety Company of America
Travelers Casualty and Surety Company
St. Paul Fire and Marine Insurance Company
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St.
Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively called the
'Companies"), and that the Companies do hereby make, constitute and appoint Isabel Barron of WATSONVILLE
California , 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 3rd day of February,
2017.
4r L9�
WATFWAi HWFM, + cmata
come'S CONK o KU
For
State of Connecticut
By: y �?;;
_ Tf
City of Hartford ss. Robert L.Raney, Se or Vice President
On this the 3rd day of February, 2017, 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 the corporations by
himself as a duly authorized officer.
In Witness Whereof, I hereunto set my hand and official seal. �.7�� C ��
My Commission expires the 30th day of June, 2021►,
* p���ps* Marie C. Tetreault, Notary Public
0<F
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.
�puu W nry�*Its got* 016
Dated this 2f1d day of April
u
U\M7,e
'�t• AryOC
2020
S U RFry
�Qv' AZ y
__ ¢ HARTFORD, ; j ONE
� X,OF a §(evin E. Hughes,
To verify the authenticity of this Power ofAttorney, ple�t�sti�"k^�00-421-3880,
please refer to the above -named Attorney -in -Fact and the detai/s o?H4e„¢,q(hd4&\wh1ch the power is attached,
Secretary
FORM OF BID OR PROPOSAL
FY 2020 CIP PIPELINING PHASE IVA
CONTRACT NO. 1014
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 Indiana , 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 AECOM 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 CIP PIPELINING PHASE IVA, CITY
CONTRACT NO. 1014, 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 CIP PIPELINING PHASE IVA
CITY OF WATERLOO, IOWA
rITV CONTRACT NO- IMA
Item
I Description
Unit
Estimated
Quantiles
Unit Price
Total Amount
BASE BID
1
8" Diameter CIP Pipe Lining
LF
8,387.00
$ =�`
$
2
10" Diameter CIP Pipe Lining
LF
350.00
$ ;'0--
$ 5C1C `v
3
12" Diameter CIP Pipe Lining
LF
975.00
$ S (—
$
4
18" Diameter CIP Pipe Lining
LF
574.00
$ 76_
o�
$ 4&1-�
5
Lateral Reinstatement
EA
156.00
$ cc—
$ 11-
6
3-FT Lateral Grouting
EA
156.00
$
$AOO
7
Pipe Televising - 8"
LF
16,774,00
$ —
$ =�
8
Pipe Televising - 10
LF
700.00
$ -�
$
010
9
Pipe Televising - 12"
LF
11950,00
$ —
$ 00 _
10
Pipe Televising - 18"
LF
1,148.00
$
$'J
11
Type A Pipe Cleaning - 8"
LF
81387,00
$ —�
$
12
Type A Pipe Cleaning - 10"
LF
350.00
$
$ i 030
13
Type A Pipe Cleaning - 12"
LF
975.00
$ S'"'
$ �{ 75--
14
Type A Pipe Cleaning - 18"
LF
574.00
$
$ 70
15
Type C Root Removal - 8"-10"
LF
4,368.00
$
16
Type C Root Removal - 12"-15"
LF
487.00
$
$ i!
17
Type C Root Removal - 18"
LF
287.00
$ s^`
$ ss
18
Type D Lumberjack - 8"-10"
LF
41368,00APA
19
Type D Lumberjack - 12"-15"
LF
487.00
$ , 5'0
FORM OF BID CONTRACT NO. 1014 Page BF-1 OF 4
AECOM 60620183 FY 2020 CIP Pipelining Ph IVA
Item
Description
Unit
Estimated
Quantiles
Unit Price
Total Amount
20
Type D Lumberjack - 18"
LF
287.00
$ S _
$ S '-
21
Protruding Taps Removal
EA
100.00
$ 5p;p
$ $ 000
22
Internal Chimney Seal
EA
54.00
$ 0r
$ S'OG cp
23
Manhole Barrel Joint Leak Repair
EA
29.00
$ 0C %-
$IYCJLYOO co
24
Manhole Lining
EA
28.00
$ cjSr --
$ Go C%
25
Grout Work
EA
12.00
$ 0000
$ 11 000
26
Box Outs
EA
4.00
1 $ afG� —
$ W 6 00 --
TOTAL BASE BID
$ 5' g g G
Item
Description
Unit
Estimated
Quantit
Unit Price
Total Price
BID ALTERNATE NO. 1 - SERVICE AREA NO. 23 WMSD
100
42" Diameter CIP Pipe Lining
LF
881.0
$ ��10
$ )06 1 LPN
101
Pipe Televising - 42"
LF
1,762.0
$ --
$ >y 010
102
Type A Pipe Cleaning - 42"
LF
881.0
$ ( 0 Is
La
ZF10
103
Type C Root Removal - 42"
LF
220.3
$ to —
$ �. >O
104
Type D Lumberjack .42"
LF
220.3
$ ,-O
$ L Yoco
105
By -Pass Pumping
LS
1.0
$ ?3'OG 6
$ 9 000
106
Traffic Control
LS
1.0
$ S 4G'
$ %00 0 _
BID ALTERNATE NO. 1 TOTAL
$
Item
Description
Unit
Estimated
Quantity
Unit Price
Total Price
BID
ALTERNATE NO. 2 - SERVICE AREA
NO 11 FARM
FIELD
200
18" Diameter CIP Pipe
Lining
LF
758.0
$
70�
$
S3
06C^
201
21" Diameter CIP Pipe
Lining
LF
394.0
$
G �c
$
S (pa o
202
Pipe Televising - 18"-21"
LF
2,304.0
$
"'
$
5)-0�°
203
Type A Pipe Cleaning
- 18"-21"
LF
1,152.0
$
GS' =
$
g' o
204
Type C Root Removal - 18"-21"
LF
100.0
$
(✓ "
$
t
000-'
205
Type D Lumberjack- 18"-21"
LF
100.0
$
—
$
-
BID
ALTERNATE
NO. 2 TOTAL
$
177
q,;L O
FORM OF BID CONTRACT NO. 1014 Page BF-2 OF 4
AECOM 60620183 FY 2020 CIP Pipelining Ph IVA
2. It is understood that the quantities set forth are approximate only and subject to variation and that the
unit bid price for the work done shall govern in the actual payment to Contractor. The Contract shall
be awarded based on the TOTAL BASE BID,
3. In submitting this bid, the bidder understands that the right is reserved by the Ciry of Waterloo, Iowa,
to reject any or all bids. If written notice of the acceptance of this bid is mailed, telegraphed, or
delivered to the undersigned within thirty (30) days after the opening thereof, or at any time thereafter
before this bid is withdrawn, the undersigned agrees to execute and deliver an agreement in the
prescribed form and furnish the required bond and certificate of the insurance within ten (10) days
after the agreement is presented to him for signature, and start work within ten (10) days after
"Notice to Proceed" is issued.
4.
5.
6.
7
Security in the sum of 5% of Bid Amount
of Bid Amount ) in the form of Bid Bond
accordance with the INSTRUCTIONS TO BIDDERS.
Attached hereto is allon-Collusion Affidavit of Prime Contractor.
is
Dollars ($ 5°%
submitted herewith in
Attached hereto is the Bidder Status Form indicating Resident Bidder Certification ( ), or
Non -Resident Bidder Certification ( ✓ ). (Mark one.)
The bidder is prepared to submit a financial and experience statement upon request.
8. The Prime Contractor and Subcontractor(s), which have performed an aggregate of $10,000.00 in
work for the City in the current calendar year, are prepared to submit an AAP or Update and an
EOC, within ten (10) days of notification that the bid submitted is lowest and acceptable.
E
The bidder has received the following Addendum or Addenda:
Addendum No.
Date
10. The bidder shall list the MBE/WBE subcontractor(s), amount of subcontracts and bid items on the
City of Waterloo Minority and/or Women Business Pre -bid Contact Information Form submitted with
this Form of Bid or Proposal. The apparent low Bidder shall submit a list of all other Subcontractor(s)
to be used on this Project to the City of Waterloo by 5:00 p.m. the business day following the day
Bids on this Project are due along with the Non -Collusion Affidavits of All Subcontractor(s).
The Contractor shall submit information on subcontractors on "SUBCONTRACTOR REQUEST AND
APPROVAL" Form to be provided by City prior to approval of contract.
The subcontractors listed on this proposal and/or submitted to the Contract Compliance Officer
cannot be changed except for the following reasons:
1) The City of Waterloo does not approve the subcontractors.
2) The subcontractors submit in writing that they cannot fulfill their subcontracts.
11. The bidder has filled in all blanks on this proposal. Those blanks not applicable are marked "none"
or "NA".
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. 1014 Page BF-3 OF 4
AECOM 60620183 FY 2020 CIP Pipelining Ph IVA
BY:
Granite Inliner, LLC
Official Address: (Including Zip Code):
19. 2020
(Date)
e Area Manager
16028 Forest Boulevard North, PO Box 353, Hugo, MN 55038
01-0684682
FORM OF BID CONTRACT NO. 1014 Page BF-4 OF 4
AECOM 60620183 FY 2020 CIP Pipelining Ph IVA
INFORMATION NEEDED
FOR
IOWA CONSTRUCTION SALES TAX EXEMPTION CERTIFICATE
CONTRACTOR NAME:
ADDRESS:
(Check One)
Granite Inliner7 LLC
16028 Forest Boulevard North, PO Box 353, Hugo, MN 55038
PRIME X
FEDERAL ID#: 01-0684682
SUBCONTRACTOR
PROJECT NAME: FY 2020 CIP PIPELINING PHASE IVA
PROJECT CONTRACT NO.: 1014
DESCRIPTION OF WORK:
❑ Brickwork
❑ Carpentry
❑ Concrete
❑ Drywall -Plaster -Insulation
❑ Electrical
❑ Excavation/Grading
❑ Flooring
❑ Heavy Construction
❑ Heating -Ventilating -Air Cond
❑ Landscaping
❑ Painting
❑ Paving
❑ Plumbing
❑ Roofing -Siding -Sheet Metal
❑ Windows
❑ Wrecking -Demolition
'Other (Please specify)
CIPP Lining
SALES TAX EXEMPTION CONTRACT NO. 1014 Page STE-1 OF 1
AECOM 60620183 FY 2020 CIP Pipelining Ph IVA
THIS PAGE LEFT BLANK INTENTIONALLY
NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
State of Minnesota )
)ss
county of Washington )
Daniel J. Banken , being first duly sworn, deposes and says that:
1. He is (Owner, PartneL Officer, epresentative, orAgent) of Granite Inliner, LLC
, the Bidder th mitted the attached Bid;
2. He is fully informed respecting the preparation and contents of the attached Bid and of all
pertinent circumstances respecting such Bid;
3. Such Bid is genuine and is not a collusive or sham Bid;
4. Neither the said Bidder nor any of its officers, partners, owners, agents, representatives,
employees, or parties in interest, including this affiant, has in any way colluded, conspired,
connived or agreed, directly or indirectly, with any other Bidder, firm or person to submit a
collusive or sham Bid in connection with the Contract for which the attached Bid has been
submitted or to refrain from bidding in connection with such Contract, or has in any manner,
directly or indirectly, sought by agreement or collusion or communication or conference with any
other Bidder, firm or person to fix the price or prices in the attached Bid or of any other Bidder, or,
to fix any overhead, profit or cost element of the bid price or the bid price of any other Bidder, or
to secure through any collusion, conspiracy, connivance, or unlawful agreement any advantage
against the City of Waterloo, Iowa, or any person interested in the Proposed Contract; and
5. The pr�gi&%b .66tv4uoted in the attached Bid4areirdproper and are not tainted by any
coll�sf�,,connivance or unlawful an the of the Bidder or any of its
ag$r1 F �9wners, employees, orere t inclu ng t ' 'affiant.
s 2p02. _ (Signed)
do May ' Daniel J. Banken, Area M ager
'��� �`•.!ND1P..•• ,�.` Title
Subs cribeUMid%Aworn to before me this 9 day of April 2020
/( (}�//� � � Operational Support
/,V1JW� Title
My commission expires January 31, 2024 SARAANNE ROBINSON
Notary Public
`yr • Minne ota
My Commission Expires Jan 31, 2024
NON -COLLUSION AFFIDAVITS CONTRACT N0.1014 Page NCA-1 OF 2
AECOM 60620183 FY 2020 CIP Pipelining Ph IVA
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
ensure 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
or advertisements for employees, state that all qualified applicants will receive consideration for
employment 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 union or
workers' representative of the contractor's commitment under this section.
4. 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.
5. 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.
6. 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.
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,
EQUAL OPPORTUNITY CLAUSE CONTRACT NO. 1014 Page EOC-1 OF 2
AECOM 60620183 FY 2020 CIP Pipelining Ph IVA
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-disyrimination
in employment. Any person who applies for e ym nt with our comp s��yy will not be
discriminated against because of race, creed, coo , s tional rigin, e mimic status, age,
mental or physical disabilities. ��
�
�NLINF��i, (Signed)
00
•tia*.*�ND1 PaP•
A, •.sees• %�
Appropriate Official)
Daniel J. Banken, Area Manager
(Title)
April 9, 2020
(Date)
EQUAL OPPORTUNITY CLAUSE CONTRACT NO. 1014 Page EOC-2 OF 2
AECOM 60620183 FY 2020 CIP Pipelining Ph IVA
TITLE VI CIVIL RIGHTS
During the performance of this contract, the contractor (for itself), its assignees, and successors in
interest (hereinafter referred to as the "contractor") agrees as follows:
1. Compliance with Regulations: The contractor shall comply with the Regulations relative to non-
discrimination in Federally assisted programs of the DOT Title 49, Code of Federal Regulations,
Part 21, as they may be amended from time to time, (hereinafter referred to as the Regulations),
which are herein incorporated by reference and made a part of this contract.
2. Nondiscrimination: The contractor, with regard to the work performed by it during the contract,
shall not discriminate on the grounds of race, color, national origin, sex, age, or disability in the
selection and retention of subcontractors, including procurement of materials and leases of
equipment. The contractor shall not participate either directly or indirectly in the discrimination
prohibited by section 21.5 of the Regulations, including employment practices when the contract
covers a program set forth in Appendix B of the Regulations.
3. Solicitations for Subcontracts, Including Procurement of Materials and Equipment: In all
solicitations either by competitive bidding or negotiation made by the contractor for work to be
performed under a subcontract, including procurement of materials or leases of equipment, each
potential subcontractor or supplier shall be notified by the contractor of the contractor's
obligations under this contract and the Regulations relative to non-discrimination on the grounds
of race, color, national origin, sex, age, or disability.
4. Information and Reports: The contractor shall provide all information and reports required by the
Regulations or directives issued pursuant there to, and shall allow access to its books, records,
accounts, other sources of information, and its facilities as may be determined by the Contracting
Authority, the Iowa DOT, or FHWA to be pertinent to ascertain compliance with such Regulations,
orders and instructions. Where any information required of a contractor is in the exclusive
possession of another who fails or refuses to furnish this information the contractor shall so certify
to the Contracting Authority, the Iowa DOT, or the FHWA as appropriate, and shall set forth what
efforts it has made to obtain the information.
5. Sanctions for Noncompliance: In the event of the contractor's noncompliance with the
nondiscrimination provisions of this contract, the Contracting Authority, the Iowa DOT, or the
FHWA shall impose such contract sanctions as they may determine to be appropriate, including,
but not limited to:
a. Withholding of payments to the contractor under the contract until the contractor
complies, and/or
b. Cancellation, termination, or suspension of the contract, in whole or in part.
6. Incorporation of Provisions: The contractor shall include the provisions of paragraphs (1) through
(6) in every subcontract, including procurement of materials and leases of equipment, unless
exempt by the Regulations, or directives issued pursuant thereto. The contractor shall take such
action with respect to any subcontract or procurement as the Contracting Authority, the Iowa
DOT, or the FHWA may direct as a means of enforcing such provisions including sanctions for
non-compliance: Provided, however, that, in the event of a contractor becomes involved in, or it
threatened with, litigation with a subcontractor or supplier as a result of such direction, the
contractor may request the Contracting Authority or the Iowa DOT to enter into such litigation to
protect the interests of the Contracting Authority or the Iowa DOT; and, in addition, the contractor
may request the United States to enter into such litigation to protect the interest of the United
States,
TITLE VI RIGHTS CONTRACT NO. 1014 Page TVI-1 of 1
AECOM 60620183 FY 2020 CIP Pipelining Ph IVA
THIS PAGE LEFT BLANK INTENTIONALLY
Bidder Status Form
To be completed by all bidders Part A
Please answer "Yes" or No for each of the following:
❑ Yes ❑ No My company is authorized to transact business in Iowa.
(To help you determine if your company is authorized, please review the worksheet on the next page).
❑ Yes ❑ No My company has an office to transact business in Iowa.
❑ Yes R No My company's office in Iowa is suitable for more than receiving mail, telephone calls, and e-mail,
❑ Yes ❑ No My company has been conducting business in Iowa for at least 3 years prior to the first request for
bids on this project.
❑ Yes No My company is not a subsidiary of another business entity or my company is a subsidiary of another
business entity that would qualify as a resident bidder in Iowa.
If you answered "Yes" for each question above, your company qualifies as a resident bidder. Please
complete Parts B and D of this form.
If you answered "No" to one or more questions above, your company is a nonresident bidder. Please
complete Parts C and D of this form.
To be completed by resident bidders Part B
My company has maintained offices in Iowa during the past 3 years at the following addresses:
Dates: / / to / / Address:
City, State, Zip:
Dates: / / to / / Address:
City, State, Zip:
Dates: / / to / / Address:
You may attach additional sheet(s) if needed. City, State, Zip:
To be completed by non-resident bidders Part C
1. Name of home state or foreign country reported to the Iowa Secretary of State:
Indiana
2. Does your company's home state or foreign country offer preferences to resident bidders, resident labor ❑ Yes ❑ No
force preferences or any other type of preference to bidders or laborers?
3. If you answered "Yes" to question 2, identify each preference offered by your company's home state or foreign country
and the appropriate legal citation.
See Attached
You may attach additional sheet(s) if needed.
To be completed by all bidders Part D
certify that the statements made on this document are true anq,6mh'i bte,�j .,the best of my knowledge and I know that my
failure to rovide accurate and truthful infor ion ma be a �a p rrFGxct rf�y bid.
,`� •0�1AB((�� j�CC�
Firm Name: Gga�li$4 InIm er, ? :'�`� , •. '
Signature:
=Date: April 9, 2020
Daniel J. Banken, Area Manager % •'••..,iNo�Pc' .�
You must submit the completed form to the governmen{Ai,l�Pd•..�e�a��ting bids per 875 Iowa Administrative Code
Chapter 156. This form has been approved ji te Iowa Labor Commissioner.
309-6001 (09-15)
BSF-1
Sec. 19. (a) This section does not apply when the purchase
description is limited to a fuel of which at least twenty percent (20%)
by volume is soy diesel/bio diesel.
(b) As used in this section, "soy diesel/bio diesel" includes fuels
(other than alcohol) that are primarily esters derived from biological
materials, including oilseeds and animal fats, for use in compression
and ignition engines.
(c) There is a price preference of ten percent (10%) for soy
diesel/bio diesel.
(d) The price preference under this section applies to a purchase
of fuel of which at least twenty percent (20%) by volume is soy
diesel/bio diesel.
As added by P.L.49-1997, SEC.1.
IC 5-22-IS-20
Preferences to Indiana businesses; rules
Sec. 20. (a) This section does not apply to the state lottery
commission created by IC 4-30-34.
(b) As used in this section, "out-of-state business" refers to a
business that is not an Indiana business.
(c) A governmental body may adopt rules to give a preference to
an Indiana business that submits an offer for a purchase under this
article if all of the following apply:
(1) An out-of-state business submits an offer for the purchase.
(2) The out-of-state business is a business from a state that
gives purchase preferences unfavorable to Indiana businesses.
(d) Rules adopted under subsection (c) must establish criteria for
detennining the following:
(1) Whether an offeror qualifies as an Indiana business under
the rules.
(2) When another state's preference is unfavorable to Indiana
businesses.
(3) The method by which the preference for Indiana businesses
is to be computed.
(e) Rules adopted under subsection (c) may not give a preference
to an Indiana business that is more favorable to the Indiana business
than the other state's preference is to the other state's businesses.
(f) Rules adopted under subsection (c) must provide that a
contract shall be awarded to the lowest responsive and responsible
offeror, regardless of the preference provided under this section, if:
(1) the offeror is an Indiana business; or
(2) the offeror is a business from a state bordering Indiana and
the offeror's home state does not provide a preference to the
home state's businesses more favorable than is provided by
Indiana law to Indiana businesses.
As added by P.L.494997, SEC.]. Annended by P.L.66-2004, SEC.3.
IC 5-2245-20.5
Indiana Code 2016
"Indiana business"; criteria, price preferences; awarding of
contracts; exception
Sec. 20.5. (a) This section applies only to a contract awarded by
a state agency.
(b) As used in this section, "Indiana business" refers to any of the
foRowing:
(1) A business whose principal place of business is located in
Indiana.
(2) A business that pays a majority of its payroll (in dollar
volume) to residents of Indiana.
(3) A business that employs Indiana residents as a majority of
its employees.
(4) A business that makes significant capital investments in
Indiana.
(5) A business that has a substantial positive economic impact
on Indiana as defined by criteria developed under subsection
(c)•
(c) The Indiana department of administration shall consult with
the Indiana economic development corporation in developing criteria
for determining whether a business is an Indiana business under
subsection (b). The Indiana department of administration may
consult with the Indiana economic development corporation to
determine whether a particular business meets the requirements of
this section and the criteria developed under this subsection.
(d) There are the following price preferences for supplies
purchased from an Indiana business:
(1) Five percent (5%) for a purchase expected by the state
agency to be less than five hundred thousand dollars
($500,000).
(2) Three percent (3%) for a purchase expected by the state
agency to be at least five hundred thousand dollars ($500,000)
but less than one million dollars ($1,000,000).
(3) One percent (1%) for a purchase expected by the state
agency to be at least one million dollars ($1,000,000).
(e) If an Indiana business offers to provide supplies manufactured,
assembled, or produced in Indiana, and if two (2) or more bids
submitted were the same, the following price preference is available
to the Indiana business, in addition to the price preference available
under subsection (d):
(1) Three percent (3%) for a purchase expected by the state
agency to be less than five hundred thousand dollars
($500,000).
(2) Two percent (2%) for a purchase expected by the state
agency to be at least five hundred thousand dollars ($500,000)
but less than one million dollars ($1,000,000).
(3) One percent (1%) for a purchase expected by the state
agency to be at least one million dollars ($1,000,000).
The Indiana department of administration shall adopt rules under
Indiana Code 2016
IC 4-22-2 to establish guidelines for determining when supplies are
manufactured or assembled in Indiana.
(f) A business that wants to claim a preference provided under this
section must do all of the following:
(1) State in the business's bid that the business claims the
preference provided by this section.
(2) Provide the following information to the department:
(A) The location of the business's principal place of
business. If the business claims the preference as an Indiana
business described in subsection (b)(1), a statement
explaining the reasons the business considers the location
named as the business's principal place of business.
(B) The amount of the business's total payroll and the
amount of the business's payroll paid to Indiana residents.
(C) The number of the business's employees and the number
of the business's employees who are Indiana residents.
(D) If the business claims the preference as an Indiana
business described in subsection (b)(4), a description of the
capital investments made in Indiana and a statement of the
amount of those capital investments.
(E) If the business claims the preference as an Indiana
business described in subsection (b)(5), a description of the
substantial positive economic impact the business has on
Indiana.
As added by P.L.66-2004, SEC.4. Amended by P.L.4-2005, SEC.33;
P.L.123-2009, SEC-1; P.L.122-2011, SEC.3.
IC 5-22-15-20.7
Repealed
(As added by P.L.79-2008, SEC.6. Repealed by P.L.133-2012,
SEC.41)
IC 5-22-15-20.9
Price preferences for local Indiana businesses
Sec. 20.9. (a) This section applies only to a contract awarded by
a political subdivision if the political subdivision provides in the
solicitation that this section applies to the purchase.
(b) As used in this section, "affected county" refers to an Indiana
county:
(1) in which the political subdivision awarding a contract under
this article is located; or
(2) that is adjacent to the county described in subdivision (1).
(c) As used in this section, "local Indiana business" refers to any
of the following:
(1) A business whose principal place of business is located in
an affected county.
(2) A business that pays a majority of its payroll (in dollar
volume) to residents of affected counties.
Indiana Code 2016
• •
r
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 [� No My business is a sole proprietorship and 1 am an Iowa resident for Iowa income tax purposes.
❑ Yes 0 No My business is a general partnership orjoint venture. More than 50 percent of the general
partners or joint venture parties are residents of Iowa for Iowa income tax purposes.
❑ Yes � No My business is an active corporation with the Iowa Secretary of State and has paid all fees
required by the Secretary of State, has filed its most recent biennial report, and has not filed
articles of dissolution.
❑ Yes ®No My business is a corporation whose articles of incorporation are filed in a state other than Iowa,
the corporation has received a certificate of authority from the Iowa secretary of state, has filed
its most recent biennial report with the secretary of state, and has neither received a certificate of
withdrawal from the secretary of state nor had its authority revoked.
❑ Yes [� 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 ❑ 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 Q No My business is a limited partnership or limited liability limited partnership which has filed a
certificate of limited partnership in this state, and has not filed a statement of termination.
❑ Yes ®No My business is a limited partnership or a limited liability limited partnership whose certificate of
limited partnership is filed in a state other than Iowa, the limited partnership or limited liability
limited partnership has received notification from the Iowa secretary of state that the application
for certificate of authority has been approved and no notice of cancellation has been filed by the
limited partnership or the limited liability limited partnership.
❑ Yes ❑ No My business is a limited liability company whose certificate of organization is filed in Iowa and has
not filed a statement of termination.
❑ Yes ❑ No My business is a limited liability company whose certificate of organization is filed in a state other
than Iowa, has received a certificate of authority to transact business in Iowa and the certificate
has not been revoked or canceled.
309-6001 (09-15)
BSF-2
GRANITE INLINER, LLC
CERTIFICATE OF SECRETARY
RESOLVED, that, effective January 2 through December 31, 2020, the individuals named on the
attached Exhibit 1 are authorized to negotiate, execute and/or attest electronic and paper documents and
contracts necessary for the conduct of the Company's affairs with respect to the submission and execution
of construction project bids, bid proposals, bid addenda and all other bid -related documents prepared and
submitted on behalf of the Company not to exceed $100,000, relating to any and all domestic construction
projects arising out of the Company's operations.
RESOLVED, that, effective January 2 through December 31, 2020, the individuals named on the
attached Exhibit 2 are authorized to negotiate, execute and/or attest electronic and paper documents and
contracts necessary for the conduct of the Company's affairs with respect to the submission and execution
of construction project bids, bid proposals, bid addenda and all other bid -related documents prepared and
submitted on behalf of the Company not to exceed $500,000, relating to any and all domestic construction
projects arising out of the Company's operations.
RESOLVED, that, effective January 2 through December 31, 2020, the individuals named on the
attached Exhibit 3 are authorized to negotiate, execute and attest electronic and paper documents and
contracts necessary for the conduct of the Company's affairs with respect to the submission and execution
of construction project bids, bid proposals, bid addenda and all other bid -related documents prepared and
submitted on behalf of the Company not to exceed $2 million, relating to any and all domestic construction
projects arising out of the Company's operations.
RESOLVED, that, effective January 2 through December 31, 2020, the individual named on the
attached Exhibit 4 is authorized to negotiate, execute and attest electronic and paper documents and
contracts necessary for the conduct of the Company's affairs with respect to the submission and execution
of construction project bids, bid proposals, bid addenda and all other bid -related documents prepared and
submitted on behalf of the Company not to exceed $5 million, relating to any and all domestic construction
projects arising out of the Company's operations.
I, Ashley M. Stinson, do hereby certify that I am duly qualified as Secretary of GRANITE
INLINER, LLC, an Indiana limited liability company (the "Company"); that the foregoing is a
true and correct copy of resolutions duly adopted effective January 2, 2020, by unanimous written
consent of the Management Committee; that the Managers acting were duly and regularly elected;
and that the resolution adopted has not been modified or repealed and is still in full force and effect.
Dated: January 2, 2020
OL1AB14
t� ::May 1' '
*00
�.
'4r4e
Ashley M. Stinson
EXHIBIT 3
$2M Authority
Area Managers
District Managers
General Managers
GRANITE INLINER9 LLC
AUTHORIZED SIGNERS
Michael Chretien, Area Manager
Nate Holmes, Area Manager
Richard Cooper, Area Manager
Tommy Robertson, Area Manager
Jesse Cole, Area Manager
Daniel Banken, Area Manager
Max Gowdy, Area Manager
Ian Blackburn, Area Manager
John Rinehart, Area Manager
Carl Smith, District Manager
Mike Cannon, District Manager
Brent Buckalew, General Manager
Jim Oban, District Manager
Mark Slack, District Manager
Tyson Crandall, District Manager
ATTESTORS
Annastacia Tooke, Operational Support
Debbie Brown, Operational Support
Jean Gorey, Operational Support
Marjorie Perdue, Operational Support
Melissa Patch, Operational Support
Melissa Zelaya, Operational Support
Monica Bovis, Operational Support
Debbie Butler, Operational Support
Sara Robinson, Operational Support
Stephanie Todd, Office Manager
Linda Andry, Operational Support
Dionna Johnson, Operational Support
Eve Tinis, Operational Support
Jenna Luz, Project Manager
Shaina Holland, Project Administrator
Diana Bolano, Proposal Coordinator
Terri Ochocki, Office Manager
Alicia Crandall, Controller
Stephanie Taylor, Operation Finance Manager
Allison Brown, Operation Finance Manager
6/18/2019
Certificate of Standing
Issue Date: 6/18/2019
I )WA SECRETARY OF STATE
PAUL D. PATE
CERTIFICATE OF AUTHORIZATION
Name: GRANITE INLINER, LLC (489FLC - 457241)
Authorized Date: 5/13/2013
Duration: PERPETUAL
State of Incorporation: INDIANA
I, Paul D. Pate, Secretary of State of the State of Iowa, custodian of the records of incorporations, certify the
following for the limited liability company named on this certificate:
a. The entity is authorized to transact business in Iowa.
b. All fees, taxes and penalties required under the Revised Uniform Limited Liability Company Act and other
laws due the Secretary of State have been paid.
c. The most recent biennial report required has been filed with the Secretary of State
d. The Secretary of State has neither revoked the company's certificate of authority nor filed a notice of
cancellation.
Certificate ID: CS170430
To validate certcates visit:
s o s. iowa. gov/ Va lid a to C e rtific a to
Paul D. Pate, Iowa Secretary of State
https://sos.iowa.gov/business/cent/Print.aspx?cs=VEAOjYjAlywQl FKnwN 1 _IYJii4Q7TXRdfY8bosbhjtE 1 &print=true 1 /1
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