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HomeMy WebLinkAboutMidwest Concrete IncM dwest Coiiciins 1an1 9835 Cottingham Rd. Peosta, IA 52068-7001 Ph: (563) 845-0947 Fax: (563) 583-1007 office@midwest-concrete.net Bid Documents Sealed Bid for Complete Construction Bid Bond FY 2020 Newell St. Rise Project, Rise Project # RM-8155(765)-9D-07 Contract No. 991 City of Waterloo May 14, 2020 at 1:00 p.m. r M idwest Concrete 9835 Cottingham Rd. Peosta, IA 52068-7001 Ph: (563) 845-0947 Fax: (563) 583-1007 office@midwest-concrete.net i n Bid Documents Sealed Bid for Complete Construction Sealed Proposal FY 2020 Newell St. Rise Project, Rise Project # RM-8155(765)-9D-07 Contract Nco 991 City of \Noted o May 14, 2020 at 1:00 p.m. • BID BOND KNOW ALL MEN BY THESE PRESENTS, that we, Midwest Concrete, Inc. as Principal, and West Bend Mutual 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 Amount Bid ryA• •#� Dollars ($ s% a . ) lawful money of thip United States, for the payment of which sum will and truly be made, we binds ourselves, our heirs, executors, administrators, and successors, jointly and severally, frmly by thesp presents; The ,condition of this obligation is such that whereas the Principal has submitted the accompanying bid dated the` s. 14th day of May ' , 20 20 for .FY 2020 1ewell Street Rise Project/Contract No. 991 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 agreetnent 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 14th day of May , A.D. 20 20 . a1/11 trka /4/1 Witness Witness '1' If By \ i% Principal By Midwest Concrete, Inc. West Bend Mutual Insurance Company Adam R..i, cador Attorney -in -fact (Seal) (Seal) (Title) A MUTUAL INSURANCE COMPANY THE SILVER LINING® Bond No. 2436371 POWER OF ATTORNEY Know all men by these Presents, That West Bend Mutual Insurance Company, a corporation having its principal office in the City of West Bend, Wisconsin does make, constitute and appoint: Adam R Meador lawful Attorney(s)-in-fact to make, execute, seal and deliver for and on its behalf as surety and as its act and deed any and all bonds, undertakings and contracts of suretyship, provided that no bond or undertaking or contract of suretyship executed under this authority shall exceed in amount the sum of. Ten Million Dollars ($10,000,000) This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of West Bend Mutual Insurance Company at a meeting duly called and held on the 215t day of December, 1999. Appointment of Attorney -In -Fact. The president or any vice president, or any other officer of West Bend Mutual Insurance Company may appoint by written certificate Attorneys -In -Fact to act on behalf of the company in the execution of and attesting of bonds and undertakings and other written obligatory instruments of like nature. The signature of any officer authorized hereby and the corporate seal may be affixed by facsimile to any such power of attorney or to any certificate relating therefore and any such power of attorney or certificate bearing such facsimile signatures or facsimile seal shall be valid and binding upon the company, and any such power so executed and certified by facsimile signatures and facsimile seal shall be valid and binding upon the company in the future with respect to any bond or undertaking or other writing obligatory in nature to which it is attached. Any such appointment may be revoked, for cause, or without cause, by any said officer at any time. In witness whereof, the West Bend Mutual Insurance Company has caused these presents to be signed by its president undersigned and its corporate seal to be hereto duly attested by its secretary this 22nd day of See tember, 2017. Attest Christopher C. Z Secretary State of Wisconsin County of Washington On the 22nd day of September, 2017, before me personally came Kevin A. Steiner, to me known being by duly sworn, did depose and say that he resides in the County of Washington State of Wisconsin; that he is the President of West Bend Mutual Insurance Company, the corporation described in and which executed the above instrument; that he knows the seal of the said corporation; that the seal affixed to said instrument is such corporate seal; that is was so affixed by order of the board of directors of said corporation and that he ; i)r�(1h - J gart 1/GORPORAre •'y tSEMI.). a. Kevin A. Steiner Chief Executive Officer/President signed his name thereto by like order. h;HeNo,, 9 nOTApy'.4' POOLIC . TF,T WiS(jC t Juli AInedum Senior orporate Attorney Notary Public, Washington Co., WI My Commission is Permanent The undersigned, duly elected to the office stated below, now the incumbent in West Bend Mutual Insurance Company, a Wisconsin corporation authorized to make this certificate Do Hereby Certify that the foregoing attached Power of Attorney remains in full force effect and has not been revoked and that the Resolution of the Board of Directors, set forth in the Power of Attorney is now in force. Signed and sealed at West Bend, Wisconsin this 14th day of May . Neu 'CORPORATE SEALt Heather Dunn Gl.°N r :IV I Vice President - Chief Financial Officer Notice: Any questions conceming this Power of Attorney may be directed to the Bond Manager at NSI, a division of West Bend Mutual Insurance Company. 1900 S. 18th Ave. West Bend, WI 53095 I ph (262) 334-6430 I 1-800-236-5004 I fax (262) 338-5058 ( www.thesilverlining.com 2020 . FORM OF BID OR PROPOSAL FY 2020 NEWELL STREET RISE PROJECT RISE PROJECT #RM-8155(765)--9D-07 CONTRACT NO. 991 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 rW 6- a Partnership consisting of the following partners: k1 i fitVg isk CO it u tyi L - 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: Item Code Item Quantity Unit Unit Price Total Price No. Excava1 Class 10, Roadway And 8,515 CY 2102-2710070 Borrowtion, 2 2105-8425011 Topsoil, Spread 2,150 CY ),a'b /4, as, oo 3 2105-8425015 Topsoil, Strip And Stockpile 2,150 CY 3.09 (0, 643.5b Subgrade Stabilization Material, 2113-0001100 6,260.9 SY 4 Polymer Grid 7..•1>'1) 07623; 2S 5 2115-0100000 Modified Subbase, 6" Thick 1,110 CY 33.00 34430. o0 6 2123-7450020 Shoulder Finishing, Earth 24.8 STA LQ, yuo oo z.sb.00 Standard Or Slip Form Portland 7 2301-1032090 Cement Concrete Pavement, Class C, 5,712.7 SY 24, S giii• o Into Class 2 Durability, 9 In. 8 2315-8275025 Surfacing,Stone Driveway, Class A Crushed 25 TON --Tj7},oD 30 Of Sign 2 EACH o0 9 2401 6745910 Removal ��o,o0 loc9 10 2416-0100018 Aprons, Concrete, 18 In. Dia 1 EACH 2O00.00 7/080 to Apron, Low Clearance Concrete, 11 2416-0102230 2 EACH Equivalent Diameter 30 In. 2iS b.00 4,3o0-0t Culvert, Low Clearance Concrete Equivalent Diameter 70 LF 12 2416-1190230 Entrance Pipe, 30 In. 190.00 % goo .DD Manhole, Storm Sewer, SW-401, 48 13 2435-0140148 In. 1 EACH 3Loo•oo 312_0o.00 14 2435 0254100 Intake, SW-541 3 EACH 4 yoo.00 i ill Vey • b0 15 2435-0254200 Intake Extension Unit, SW-542 4 EACH 4S00•00 /kpoo.00 16 2435-0254500 Intake, SW-545, LO = 12' 1 EACH 4500.00 tit Sbo-co FORM OF BID 1 of CONTRACT NO. 991 Page 17 2435 0600020 Manhole Adjustment, Major 1 EACH /coo.00 wbf9, op Subdrain, Longitudinal, (Shoulder) 6 18 2502-8212036 2 117 LF gas- In. Dia. owls' 19 2502-8221006 Subdrain Riser, 6 In., As Per Plan 4 10o0•00 EACH /2 bop oo 20 2502-8221303 Subdrain Outlet, DR-303 6 EACH (b5b.o0 (o3o0•oO Storm Sewer Gravity Main Trenched, 21 2503-0114215 Reinforced Concrete Pipe (RCP), 452 LF 2000D (Class III),15 In 31•5t) Nat 22 2503-0114218 Storm Reinforced Sewer Concrete Gravity Main Pipe Trenched, 2000D (Class III),18 In (RCP), 230 LF 3?"‘ co intiD,to 23 2503-0200036 Remove Storm Sewer Pipe Less Than 155 LF Or Equal To 36 In. /0•60 1SS0.•oo 24 2507-6800061 Revetment, Class E 47.2 TON VS(oo 2/2.4.00 25 2510-6745850 Removal Of Pavement 3,311 SY 6.7o 2.2 f1P3,'to 26 2518-6910000 Safety Closure 2 EACH r n 3. oo Z 04.00 27 2527-9263109 Painted Pavement Marking, 13.95 STA Waterborne Or Solvent n2g 0 2-9.61 -Based / Pre-cut Symbol and Legend, Preform 28 2527-9263155 Thermoplastic 3 EACH co.70 15 (4,t 0 29 2528-8445110 Traffic Control 1 LS L31A.00 230,00 30 2533-4980005 Mobilization 1 LS 9goo/co 95000.00 Water Ma'n, Trenched, Ductile Iron 31 2554-0112016 Pipe (DIP), 16 In. 568 LF / 20• 00 4 ivleo• op 32 2554-0210201 Fire Hydrant Assembly 1 EACH 53t cD �3 n 0 •oo 33 2599-9999005 Removal Of Fire Hydrant Assembly 1 EACH /o®®.co oce• 00 / 34 2599-9999005 Install 16 In. Gate Valve (DIP) 3 EACH F/po.ao 2atleo.00 35 2599-9999005 Remove And Reinstall Fence Gate 1 EACH j000.00 /voo.o0 36 2599-9999009 Removal Of Watermain oO 500 LF 8. (ovo. bO 37 2601-2640350 Special cial Ditch Control, Wood Excelsior 112 SQ 1sAt S 104,5; 38 2601-2634150 Mulching, Wood Cellulose Fiber 2.13 ACRE / 1602, •ib 7 gn . 33 39 2601-2636043 Seeding And Fertilizing (Rural) 1.46 ACRE t 313, 2S L 919-, 33- 40 2601-2636044 Seeding And Fertilizing (Urban) 0 67 ACRE 1 15? 00 1 311 ,/g 41 2602-0000020 Silt Fence 1 933 LF 140 3V79, yo 42 2602-0000030 Silt Fence For Ditch Checks 199 LF cm loft/ MO Removal Of Silt Fence Or Silt Fence 43 2602-0000071 2,132 LF For Ditch Checks in 769;CZ Maintenance Of Silt Fence Or Silt 44 2602-0000101 2 132 LF Fence For Ditch Check , 26 32. Se -St • Stabilized Construction Entrance, EC- 45 2602-0000150 303 100 LF o 1 e• 0 / $o 0$00 46 2602-0000500 Open -Throat Curb Intake Sediment 46 LF Filter, EC-602 L 3 e41 411* a Maintenance Of Open -Throat Curb 47 2602-0000510 4 EACH /vnto0 Intake Sediment Filter ZS,}S Removal Of Open Curb Intake -Throat 48 2602-0000520 4 EACH Sediment Filter 5'1,s0 toy„ 00 49 2602-0010010 Mobilizations, Erosion Control 4 EACH sr00•6b Zboo, 00 TOTAL BID 7 1, 140 13, FORM OF BID 2 of 4 CONTRACT NO. 991 Page 2. It is understood that the quantities set forth are approximate only and subject to variation and that the unit bid price for the work done shall govern in the actual payment to Contractor. 3. In submitting this bid, the bidder understands that the right is reserved by the City of Waterloo, Iowa, to reject any or all bids. If written notice of the acceptance of this bid is mailed, telegraphed, or delivered to the undersigned within thirty (30) days after the opening thereof, or at any time thereafter before this bid is withdrawn, the undersigned agrees to execute and deliver an agreement in the prescribed form and furnish the required bond and certificate of the insurance within ten (10) days after the agreement is presented to him for signature, and start work within ten (10) days after "Notice to Proceed" is issued. 4. Security in the if cc, 0-\ vvvHA #* ' ,j Dollars ($ j irch ) in the form of VA n�;£ with the INSTRUCTIONS TO BIDDFRS. 5. Attached hereto is a NonCollusion Affidavit of Prime Contractor. sum of , is submitted herewith in accordance 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 FOC, 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. IUJ ( 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 RESUEST 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 Page 3 of 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 Ivk h evvcieft (Name of Bidder) (Da e) BY• Title Pf'QSI*A.A-4- Official Address: (Including Zip Code): I.R.S. No. 3� `" 2t7 2141 FORM OF BID CONTRACT NO. 991 Page 4 of 4 NON -COLLUSION AFFIDAVIT OF PRIME BIDDER State of \ V`f ) County of D lip 9&J " \AA, ) i� In �0 wk€s , being first duly swom, deposes and says that: 1. He is (Owner, Partner, Officer, Representative, or Agent) of 0 VT(V\ e. t ,&v4 LW (at tkv}cthe 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 mariner, 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) PUS at vcir Title 1 LA .. .t,n day of (NA Cun ,20LQ Subscribed and sworn to before me this )ss My commission expires CA ", (p_a • Nov Title AMANDA M. WESSELS Notarial Seal— State of Iowa " Commission Number 712724 /ow & My Ca,xnission Expires [v Y,y NON -COLLUSION AFFIDAVIT OF SUBCONTRACTOR State of ) County of ) being first duly sworn, deposes and says ) ss: that: 1. He is (Owner, Partner, Officer, Representative, or Agent) , of hereinafter referred to as the "Subcontractor;" 2. He is fully informed respecting the preparation and contents of the subcontractor's proposal submitted by the subcontractor to , contract pertaining to the project in • , (City or County and State) 3. Such subcontractor's proposal is genuine and is not a collusive or sham proposal; 4. Neither the subcontractor 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 proposal in connection with such contract or to refrain from submitting a proposal in connection with such contract, or has in any manner, directly or indirectly, sought by unlawful agreement or connivance with any other bidder, firm or person to fix the price or prices in said subcontractor's proposal, or to fix any overhead, profit or cost element of the price of prices in said subcontractors proposal, or to secure through 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 subcontractor's proposal are fair and proper and are not tainted by any collusion, conspiracy connivance or unlawful agreement on the part of the bidder or any of its agents, representatives, owners, employees, or parties in interest, including this affiant (Signed) Subscribed and sworn to before me this 20_ Title day of Title My commission expires 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. EQUAL OPPORTUNITY CLAUSE PAGE 1 OF 2 PAGES 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, 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. 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) (Appropriate Official) (Title) fcr tutias (Date) EQUAL OPPORTUNITY CLAUSE PAGE 2 OF 2 PAGES 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. 3idder 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. help determine if is the the (To you your company authorized, please review worksheet on next page). [Yes 0 No My company has an office to transact business in Iowa. [71 Yes ❑ No My in Iowa is for than telephone company's office suitable more receiving mail, calls, and e-mail 'Yes My has been business in Iowa for least 3 to the first for 0 No company conducting at years prior request bids on this project. My is business is of Yes ❑ No company not a subsidiary of another entity or my company a subsidiary another T11TTT��� business entity that "Yes' would qualify as a resident bidder in Iowa. If for bidder. Please you answered each question above, your company qualifies as a resident complete Parts B 'No" and D of this form. If answered to is nonresident bidder. Please you one or more questions above, your company a complete Parts C and D of this form. To be completed by resident bidders Part B My Dates: company C has maintained / 1.5 / 11 offices in to (i Iowa toynead- during the past / 3 years Address: at the following D5 addresses: 1,6A-V1n VIOL +,^ VA City, State, Zip* ftes - k. t (;& dr c Dates: L Lk l / 1 / 112 to c / 6 / 1 i Address* 1.4VLefil N A V a v Y e C City, State, Zip* f to S% 1 A G 9 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 home foreign to the Iowa Secretary State: of state or country reported of 2. Does home foreign to bidders, labor company's state or country offer resident resident your preferences Yes ❑ No force preferences or any other type of preference to bidders or laborers? "Yes' 3. If to 2, identify by home foreign and the you appropriate answered legal citation question each preference offered your company's state or country You may attach additional sheet(s) if needed. To be completed by all bidders Part D I that the this document true to the best knowledge I know that certify statements made on are and complete of my and my failure to provide accurate and truthful information may be a reason to reject my bid. Al eSiC QO'Vl hill Firm Name. CY 2kC', Signature: �� r L31A Date: c' VA" 7/CS You must submit the Chapter completed 156. form This form to the governmental has been approved 309-6001 (09 body 15) by requesting the Iowa Labor bids per 875 Commissioner. Iowa Administrative Code 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. Ves T1'es [59Yes 0Yes ■ • Yes Yes • No My business is currently registered as a contractor with the Iowa Division of Labor. No My business is a sole proprietorship and I am an Iowa resident for Iowa income tax purposes. 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. 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 ❑ Yes No Yes No ❑ Yes 171 No ■ Yes 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. 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 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. 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) Prime Contractor Name. MBE/WBE BUSINESS ENTERPRISE PRE -BID CONTACT INFORMATION FORM ,U„ VI C� � C�1 KL, Project: WZO Ntwc-C I S+ . �a sv {coos- Letting Date: On I )03 NO MBE/WBE SUBCONTRACTORS: If ou ar- NOT using any MBE/WBE subcontractors to complete this project, sign below. Attach a brief explanation as to why sub portion of this form. Contractor Signature: easible with this project If any MBE/WBE subcontractors will be used, please use the bottom Title: 09\ex,,is )1c Date: 7A 4i2 c7 V SUBCONTRACTORS PPLICABLE: 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 OF INFORMATION SHOWING BIDDER'S PRE -BID MBE/WBE BUSINESS ENTERPRISE CONTACTS Quotes Received Quotation used in bid Yes/No Dates Contacted Yes/No MBE/WBE Dates Contacted Dollar Amount Proposed be Subcontracted to Subcontractors (Form CCO-4) Rev. 06-20-02 County '% CAC— V `C" \AI t City A ok_k t (U.n Form 730007WP 7-97 Contractor 0-A I We Si' 0 ill C (e F, ` n L Project/ GICI TARGETED SMALL BUSINESS (TSB) PRE -BID CONTACT INFORMATION (To Be Completed By All Bidders Per The Current Contract Provision) Page# 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. TABLE OF INFORMATION SHOWING BIDDERS PRE -BID TARGETED SMALL B SUBCONTRACTOR TSB DATES QUOTES RECEIVED QUOTATION USED IN BID YES/ Mr) DATES r nNTArTFn YES/ Mel DOLLAR AMT. PROPOSED Trl RP RI IRr'nNTRACTFrI CONTACTED TUC. /U oft- _. t yes 5:76/20 VS `1.es A-, i-311.4te(09 54 3/1 o Total dollar amount proposed to be subcontracted to TSB on this project $ , (7 `fig List items by name to be subcontracted: We are a concrete paving company, none of the subs would be able to do the work with as high of a quality at a lower price than our own. None of the other people on the list would be applicable on the list for this project.