HomeMy WebLinkAboutVieth Construction CorpVieth Construction
Corporation
6419 Nordic Dr.
Cedar Falls, IA 50613
Lc-6 C' GT `l eest,(Yz-eit..._
e tA) CAJ CCC
gen- 6 to &Ai°,
Y
Vieth Construction
Corporation
6419 Nordic Dr.
Cedar F&t to 506Jcz
(0,3 Icr) a n Ockzit__
/UtCiJttC' S7 ;
15e0 a A) ctoS��
le,40
BID BOND
KNOW ALL MEN BY THESE PRESENTS, that we, Vieth Construction Corporation
as Principal, and North American Specialty Insurance 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 Submitted ---
Dollars ($---5%--- ) lawful money of the United States, for the payment
of which surn 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 14th day of May
•
2020 , for FY 2020 Newell Street RISE Project, RISE Project
. #RM-815sz65) -07, Contract No. 991; Waterloos _____
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 4th day of May , AD 2020
Vieth Construction Corporation (Seal)
Principal
Witn
tiAat
Anne Crowner
By
By
Specialty Insurance. omparkYseal)
Attorney-'. act
io a R. Young
SWISS RE CORPORATE SOLUTIONS
NORTH AMERICAN SPECIALTY INSURANCE COMPANY
WASHINGTON INTERNATIONAL INSURANCE COMPANY
WESTPORT INSURANCE CORPORATION
GENERAL POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, THAT North American Specialty Insurance Company, a corporation duly organized and existing under
laws of the State of New Hampshire, and having its principal office in the City of Overland Park, Kansas and Washington International Insurance
Company a corporation organized and existing under the laws of the State of New Hampshire and having its principal office in the City of Overland
Park, Kansas, and Westport Insurance Corporation, organized under the laws of the State of Missouri, and having its principal office in the City of
Overland Park, Kansas each does hereby make, constitute and appoint:
JAY D. FREIERMUTH, CRAIG E. HANSEN, BRIAN M. DEIMERLY, SHIRLEY S. BARTENHAGEN, CINDY BENNETT, ANNE CROWNER,
TIM McCULLOH„ STACY VENN, DIONE R. YOUNG, and WENDY ANN CASEY JOINTLY OR SEVERALLY
Its true and lawful Attorneys) -in -Fact, to make, execute, seal and deliver, for and on its behalf and as its act and deed, bonds or other writings
obligatory in the nature of a bond on behalf of each of said Companies, as surety, on contracts of suretyship as are or may be required or permitted by
law, regulation, contract or otherwise, provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the
amount of:
ONE HUNDRED TWENTY FIVE MILLION ($125,000,000.00) DOLLARS
This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of
Directors of North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held
on March 24, 2000 and Westport Insurance Corporation by written consent of its Executive Committee dated July 18, 2011.
"RESOLVED, that any two of the President, any Senior Vice President, any Vice President, any Assistant Vice President,
the Secretary or any Assistant Secretary be, and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named
in the given Power of Attorney to execute on behalf of the Company bonds, undertakings and all contracts of surety, and that each or any of them
hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is
FURTHER RESOLVED, that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any
certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be
binding upon the Company when so affixed and in the future with regard to any bond, undertaking or contract of surety to which it is attached."
By
P. Anderson, Senior Vice President of Washington International Insurance Company
& Senior Vice President of North American Specialty Insurance Company
& Senior Vice President of Westport Insurance Corporation
By
Mike A. Ito, Senior Vice President of Washington International Insurance Company
& Senior Vice President of North American Specialty Insurance Company
& Senior Vice President of Westport Insurance Corporation
IN WITNESS WHEREOF, North American Specialty Insurance Company, Washington International Insurance Company and Westport
Insurance Corporation have caused their official seals to be hereunto affixed, and these presents to be signed by their authorized officers this
this 3rd day of November , 20 17
State of Illinois
County of Cook
On this 3rd day of November , 20 17, before me, a Notary Public personally appeared Steven P. Anderson , Senior Vice President of
ss:
North American Specialty Insurance Company
Washington International Insurance Company
Westport Insurance Corporation
Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and Senior Vice President of
Westport Insurance Corporation and Michael A. Ito Senior Vice President of Washington International Insurance Company and Senior Vice President
of North American Specialty Insurance Company and Senior Vice President of Westport Insurance Corporation, personally known to me, who
being by me duly sworn, acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the
voluntary act and deed of their respective companies.
a
_ __
OFFICIAL SEAL
M KENNY
Notary Public - State of llliwi%
My Commission Expires M.Kenny, NotaryPublic
12/04/2021
r
•
I, Jeffrey Goldberg , the duly elected Vice President and Assistant Secretary of North American Specialty Insurance Company, Washington
International Insurance Company and Westport Insurance Corporation do hereby certify that the above and foregoing is a true and correct copy of a
Power of Attorney given by said North American Specialty Insurance Company, Washington International Insurance Company and Westport Insurance
Corporation which is still in full force and effect.
IN WITNESS WHEREOF, I have set my hand and affixed the seals of the Companies this 4th day of May 2020
/111-dr-
Jeffrey Goldberg, Vice President & Assistant Secretary of Washington International Insurance Company &
North American Specialty Insurance Company & Vice President & Assistant Secretary of Westport Insurance Corporation
FORM OF BID OR PROPOSAL
FY 2020 NEWELL STREET RISE PROJECT
OS,; PROJECT #RIVIn8155(765) 9 �0`7
C*WRAC T Nt 991
CITY OF WATERLOO, IOWA
Honorable Mayor and City Council
Waterloo, Iowa
Gentlemen:
The undersigned, being a Corporation existing under the laws of the State of
rt.e.r ac-09- , a Partnership consisting of the following partners:
having
familiarized (himself) (themselves) (itself) with the existing conditions on the project area
affecting the cost of the work, and with all the contract documents listed in the Table of Contents
and Addenda (if any), as prepared by the City Engineer of the City of Waterloo now on file in the
office of the City Clerk, City Hall, Waterloo, Iowa, hereby proposes to furnish all supervision,
technical personnel, labor, materials, machinery, tools, appurtenances, equipment, and
services, including utility and transportation services required to construct and complete this FY
2020 NEWELL STREET RISE PROJECT, Contract No. 991, all in accordance with the above -
listed documents and for the unit prices for work in place for the following items and quantities:
No.
Item
Code
Item
Quantity
Unit
Unit
Price
Total
Price
1
8,515
CY
,
/Lc.)
Excavation,
Class
10,
Roadway
And
2102-2710070
Borrow62,
2
2105-8425011
Topsoil,
Spread
2,150
CY
9- '
euc.
3
2105-8425015
Topsoil,
Strip
And
Stockpile
2,150
CY
3 -"
C ,j'a
4
2113-0001100
6,260.9
SY
ee
�,,��/.
3_sPolymer
Subgrade
Stabilization
Material,
Grid
5
2115-0100000
Modified
Subbase,
6"
Thick
1,110
CY
:,,^ Sv
90 4.96- es
6
24.8
STA
/-^G'
1 ? to
2123-7450020
Shoulder
Finishing,
Earth
2301-1032090
SY
co
ri
Ze _l��-
Standard
Or
Slip
Form
Portland,
Cement
Concrete
Pavement,
Class
C,
7
5,712.7
Class
2
Durability,
9
In.
ar
8
Surfacing,
Driveway,
Class
A
Crushed
25
TON
3c,
�--
7.c a e
2315-8275025
Stone
9
2
5-6
Avv
2401-6745910
Removal
Of
Sign
EACH
10
2416-0100018
Aprons,
Concrete,
18
In.
Dia.
1
is leo e
/S,a
EACH
11
2416-0102230
Apron,
Low
Clearance
Concrete,
2
i? Coe ��)3
S _.
EACH
Equivalent
Diameter
30
In.
12
2416-1190230
Culvert,
Low
Clearance
Concrete
/00
7c'c4
LF
70
Entrance
Pipe,
Equivalent
Diameter
30
I
n
.
13
2435-0140148
Manhole,
Storm
Sewer,
SW-401,
48
1
3occr
3ccx)
In.
EACH
14
2435-0254100
Intake,
SW-541
3
02ocr
rL, too--
EACH
15
2435-0254200
4
3,3cfro
/3, 2oc
Intake
Extension
Unit,
SW-542
EACH
16
2435-0254500
1
coat.
Sa cc,, -
Intake,
SW-545,
LO
= 12'
EACH
FORM OF BID
1 of
CONTRACT NO. 991
Page
Manhole
Adjustment,
Major
1
Z-5ct
ZS6c°
17
2435-0600020
EACH
18
2502-8212036
Subdrain,
Longitudinal,
6
e
(Shoulder)
Z?
2,117
In.
Dia.
LF
a
2i
19
2502-8221006
4
5.52 e
22,66
In.,
As
Per
Plan
EACH
Subdrain
Riser,
6
20
2502-8221303
6
'
Subdrain
Outlet,
DR-303
EACH
a
/0 S
21
2503-0114215
452
Storm
Sewer
Gravity
Main,
Trenched,
LF
Pipe
Reinforced
Concrete
(RCP),
9-S-
i0,3 rat
2000D
(Class
III),15
In
22
2503-0114218
Storm
Sewer
Gravity
Main,
Trenched,
230
LF
is
-
Reinforced
Concrete
Pipe
(RCP),
2000D
(Class
III),18
In
6 r
/4 7IO
23
2503-0200036
155
Storm
Sewer
Pipe
Less
Than
Remove
LF
ar
/3
sea
Lc/
Or
Equal
To
36
In.
TON
�, '
21 Z e
47.2
24
2507-6800061
Revetment,
Class
E
3,311
SY
4,
4 .?, 4 St
Of
Pavement
25
2510-6745850
Removal
esa
...c2
26
2518-6910000
Safety
Closure
2
-
-
EACH
/10
tic
Painted
Pavement
Marking,
13.95
STA
2.5-- '
,/ � �— 7''
1 �J "-`
27
2527-9263109
Waterborne
Or
Solvent
-Based
Legend,
Preform
3
Pre-cut
Thermoplastic
Symbol
and
'
28
2527-9263155
EACH
rSt
care
fd,
29
2528-8445110
Traffic
Control
1
LS
sow
3 U __
30
2533-4980005
Mobilization
1
LS
J
31
2554-0112016
Water
Main,
Trenched,
Ductile
Iron
568
LF
LG -
��;
% Cc
Pipe
16
In.
(DIP),
32
2554-0210201
1
EACH
Fire
Hydrant
Assembly
Seca.,
s--e
33
2599-9999005
1
er
EACH
/cam
•
Removal
Of
Fire
Hydrant
Assembly
w goo
34
2599-9999005
3
'
—
Valve
EACH
91.roo
Install
16
In.
Gate
(DIP)
Zercv
35
2599-9999005
1
Fence
Gate
EACH
Al vC
CCLi der
Remove
And
Reinstall
36
2599-9999009
500
LF
as -
9vo,..-)c)
Of
Watermain
Removal
112
SO
--
Special
Ditch
Control,
Wood
Excelsior
Mat
37
2601-2640350
ara
9 Z
38
2601-2634150
2.13
a r
ACRE
`' 2 j
3 rcj;
Mulching,
Wood
Cellulose
Fiber
39
2601-2636043
1.46
J
/6
ACRE
/roci y
23 Cc)
Seeding
And
Fertilizing
(Rural)
40
2601-2636044
ACRE
Aj
v 7i
0.67
Seeding
And
Fertilizing
(Urban)
41
2602-0000020
1,933
`
—
Silt
Fence
LF
2.
38 Erc,
42
2602-0000030
199
-
??�— -
Silt
Fence
For
Ditch
Checks
LF
5
2,132
Removal
Of
Silt
Fence
Or
Silt
Fence
LF
So-
43
2602-0000071
O
%0 C 6
For
Ditch
Checks
44
2602-0000101
2,132
Maintenance
Of
Silt
Fence
Or
Silt
1 Ss'
LF
s---33
6
Fence
For
Ditch
Check
. --
45
2602-0000150
100
Stabilized
Construction
Entrance,
EC-
LF
It e
303
7...ckad,
46
2602-0000500
Open
Curb
Intake
Sediment
46
-Throat
LF
��
Filter,
EC-602
Maintenance
Of
Open
Curb
4
-Throat
47
2602-0000510
EACH
Intake
Sediment
Filter
��
48
2602-0000520
Curb
Intake
4
Removal
Of
Open
-Throat
EACH
Sediment
Filter
49
2602-0010010
4
2
EACH
4G
Mobilizations,
Erosion
Control
TOTAL B I D
FORM OF BID
2of4
CONTRACT NO. 991
Page
2. It is understood that the quantities set forth are approximate only and subject to variation and
that the unit bid price for the work done shall govern in the actual payment to Contractor.
3. In submitting this bid, the bidder understands that the right is reserved by the City of Waterloo,
Iowa, to reject any or all bids. If written notice of the acceptance of this bid is mailed,
telegraphed, or delivered to the undersigned within thirty (30) days after the opening thereof, or
at any time thereafter
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. Security � , in the sum of
741~`
�4<4 ,%�,, ,,,,- Dollars ($ 51-to
in the form of 0,49 c7oo , 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 Bidder Status Form.
7. 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 $10,000.00
in work for the City in the current calendar year, are prepared to submit an AAP or Update and
an EOC, within ten (10) days of notification that the bid submitted is lowest and acceptable.
9. The bidder has received the following Addendum or Addenda:
Addendum No.
Date t°
10. The bidder shall list the MBE/WBE subcontractor(s), amount of subcontracts and bid items on
the City of Waterloo Minority and/or Women Business Pre -bid Contact Information Form
submitted with this Form of Bid or Proposal. The apparent low Bidder shall submit a list of all
other Subcontractor(s) to be used on this Project to the City of Waterloo by 5:00 p.m. the
business day following the day Bids on this Project are due along with the Non -Collusion
Affidavits of All Subcontractor(s).
The Contractor shall submit information on subcontractors on "SUBCONTRACTOR RE • UEST
AND APPROVAL" Form to be provided by City prior to approval of contract.
The subcontractors listed on this proposal and/or submitted to the Contract Compliance Officer
cannot be changed except for the following reasons:
1) The City of Waterloo does not approve the subcontractors.
2) The subcontractors submit in writing that they cannot fulfill their subcontracts.
FORM OF BID CONTRACT NO. 991
3of4
Page
BID BOND
dbtdg
KNOW ALL MEN BY THESE PRESENTS, that we,
as Principal, and
as Surety are held and firmly bound unto the CiTY OF WATERLOO , Iowa, hereinafter called
"OWNER." In the penal sum
Dollars ($ ) 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,
•
(h) 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
agreernent 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 cot porations, have caused their corporate seals to be hereto affixed and these presents to be
signed by their proper officers this day of , A.D. 20
(Seal)
Principal
By
(Title)
(Seal)
Witness Surety
By
Witness Attorney -in -fact
NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
State of CaJ'.
County o
)ss
UA-iVfLeing first duly sworn, deposes and says that:
1. He is (Owner, Partner, Officer, Representative, or Agent) , of 1/(1
, the 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 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, representatives, owners, employees, or parties in interest, including this
affiant.
ra
(Signed)
Subscribed. and sworn to before me this
` , 2 p��
C
L)
Title
I�
•
My commission expires IS
day of
Title
3lld.'er Status Forrn
To be completed by alll bidders Part A
Please answer "Yes" or "No" for each of the following:
0Yes I I 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.
es U 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.
[1 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:
Vieth Construction
Dates: � 3 G / to 7 �'1"`�54€1/417 Address:
Corpor�t;on
City, State, Zip: Ced6419
Norciic 5061aDates: / / to /_ / Address
City, State, Zip:
/ i to / / Address:
You may attach additionsl sheet(s) if needed. City, State, Zip:
Dates:
To be completed by non=resident bidders art C
1. Name of home state or foreign country reported to the Iowa Secretary of State:
2 Does your company's home state or foreign country offer preferences to resident bidders, resident labor
• force preferences or any other type of preference to bidders or laborers?
3. If you answered "Yes" to question 2, identify each preference offered by your company's home state or foreign country
• and the appropriate legal citation.
n Yes n No
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: fr it,- Cat'
Cgclf crte)
Signature:
Date:
You must submit the completed form to the governmental body requesting bids per 875 Iowa Administrative Code
Chapter 156. This form has been approved by the Iowa Labor Commissioner.
309-6001 (09-15)
riksh
AuthoratHon to Transact Rusitr ess
This worksheet may be used to help complete Part A of the Resident Bidder Status form. If at least one of the following
your business,
describes
you are authorized to transact business in Iowa.
es
n Yes
n Yes
Yes ,
■
No
My business is currently registered as a contractor with the Iowa Division of Labor.
My business is a sole proprietorship and I am an Iowa resident for Iowa income tax purposes.
My business is a general partnership or joint venture. More than 50 percent of the general
partners or joint venture parties are residents of Iowa for Iowa income tax purposes.
My business is an active corporation with the Iowa Secretary of State and has paid all fees
required by the Secretary of State, has filed its most recent biennial report, and has not filed
articles of dissolution.
Yes f I No My business is a corporation whose articles of incorporation are filed in a state pother 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 fl No My business is a limited liability partnership which has filed a statement of qualification on in a
state other than Iowa, has filed a statement of foreign qualification in Iowa and a statement of
cancellation has not been filed.
fl Yes n No
Yes n 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.
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.
n Yes n 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 n 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)
Prime Contractor Name: Vtge�
\f BEANBE BIL,S11KESS ENTIERPRlS-
PRJF fiD CONTACT I1NEORMATIION FORM
Project: tAda
Letting Date:
NO iMBEiVVBE SLBCONTRAC ORS: If you are NOT using any MBE VBE 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: �G'rG.s
Date:
SUBCONTRACTORS APPLICABLE: L1ICABLE: You are required, in order for your bid to be considered responsive, to provide the Information on this form
showing ALL of your MBE/WBE subcontractor contacts made for your bid submission. This information is subject to verification. Any questions
should be directed to Contract Compliance Office 319-291-4429.
You are required, in order for your bid to be considered responsive, to provide the information on this Form showing your MBE/WBE Business
Enterprise contacts made prior to your bid submission. This information is subject to verifications and confirmation.
If you are unable to identify MBE/WBE firms to perform portions of the work, please contact Rudy Jones, Contract Compliance Officer, for
assistance at (319) 291-4429.
In the event it is determined that the MBE/WBE Business Enterprise goals are not met, then before awarding the contract the City of waterloo will
make a determination as to whether or not the apparent successful low bidder made good faith efforts to meet the goals.
TABLE •F IIKFORM
WBE/WRE BUS
TICN- SHOWI1NO 311DDEIR°S PRE�BlD
UY SS EXTER?RUS ;-- CONTACTS
Quotes Receive Quotation usecl in It
MBE/BE
Subcontractors
Dates
Contacted
Yes/No
Dates
Cotacte .
Yes/No
Dollar Amount Proposes. to
be Subcontracted
tet4-7
eceita,ns cc)et.ir;
P1-1-#7re
oc catiefi.
cliftcs
fleei
/2.
off
Ncd
c
(Form CCO-4) Rev. 06-20-02
le Alt cara__D
Form 730007WP 7-97
Contractor
V/brq ccieLi j;
Project# Ait6C1 t&C_ S'r°
County
City
Ca -
TARGETED SMALL BUSINESS (TSB)
PRE -BID CONTACT INFORMATION
(To Be Completed By All Bidders Per The Current Contract Provision)
Page# --G
In order for your bid to be considered responsive, you are required to provide information on this form showing your Targeted Small Business contacts made with your bid submission. This information is subject to
verification and confirmation.
In the event it is determined that the Targeted Small Business goals are not met, then before awarding the contract, the Contracting Authority will make a determination as to whet her or not the apparent successful low
bidder made good faith efforts to meet the goals.
NOTE: Every effort shall be made to solicit quotes or bids on as many subcontractable items as necessary to achieve the established goals. If a TSB's quote is used in the bid, it is assumed that the firm listed will be used
as a subcontractor.
SUBCONTRACTOR
rA- s*cc J7-;
TABLE OF INFORMATION SHOWING BIDDERS PRE -BID
TARGETED SMALL BUSINESS (TSB) CONTACTS
TSB
DATES
CONTACTED
57clier.)
Total dollar amount proposed to be subcontracted to TSB on this project $ List
items by name to be subcontracted:
QUOTES RECEIVED
YES/
nin
Alfa
DATES
nnTArTFn
c7/2
QUOTATION USED IN BID
YES/
nin
0
DOLLAR AMT. PROPOSED
Tn RP RI IRCMITRACTFn