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HomeMy WebLinkAboutLodge Construction Inci •. hh a P4. Box 4592 1 O` •Mk : a; Lk 50619 CHiy aeliC \Ai rAe be ) RBE= Fy;14X Newell 5-4-(4 Rise_ P.O. BOX 45 a CLA S ILLL it -n 50619 C 61 cc-lec Ico j Re: r/- aooz )30Net— Ale,,oed 3 -1-Pc&c.,+---- BID BOND KNOW ALL MEN BY THESE PRESENTS, that we, Lodge Construction, Inc. 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 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 Pnncipal has submitted the accompanying bid dated the 14th day of May 2020 , for FY 2020 Newell Street RISE Project, RISE Project JLRM-8155(7651--9D-071Cnntract..No.99i,_W_aterloo,JA 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 llth day of May , A D. 2020 Lodge Construction, Inc. (Seal) Principal By z//. North American S • ecialty Insurance Compa r,aj1 ure ! Witness Attorney -in -fact Anne Crowner Mtle) 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." 00011I1111111/001 k1gIONAtp 4943. GQRP ALO/, �.5'G yea SE''S = C0: .0 t- • : rn Ao �s '�'•Sil .......••••• al"MTh in WOO' By Steven 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 North American Specialty Insurance Company Washington International Insurance Company Westport Insurance Corporation ss: November 20 17, before me, a No Public personally appeared Steven P. Anderson , 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 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. L ..... i a a. Sawa .. OFFICIAL SEAL M. KENNY Notary Public - State of Illinois My Commission expires 12ro412021 • M. Kenny, Notary Public 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 11 th day of May 2020 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 BI O OR PROPOSAL FY 2020 NEWELL STREET RISE PROJECT RISE PROJECT #RW8155(765)an9D 17 CONTRACT NO. 991 CITY I F WATERLO Honorable Mayor and City Council Waterloo, Iowa Gentlemen: IOWA 1. The undersigned, being a Corporation existing under the laws of the State of - , 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 Excavation, Class 10, Roadway And �-S7)LI7Borrow ,47 "`- 2102-2710070 9)600 O (5t Q= 2 2105-8425011 Topsoil, Spread 2,150 CY 3 2105-8425015 Topsoil, Strip And Stockpile 2,150 CY 3 `les- 4 2113-0001100 6,260.9 SY �1 �n�� 8 Subgrade Stabilization Material, Polymer Grid y(R)SI q 3 31,�y0 J72O .1 5 2115-0100000 Modified Subbase, 6" Thick 1,110 CY r m `t ��=.._ 6 24.8 STA 2123-7450020 Shoulder Finishing, Earth 2301-1032090 SY ,f6 0 & Standard Cement Concrete Or Slip Form Pavement, Portland Class C, 7 5,712 7 Class 2 Durability,�,t 9 In. 8 Surfacing, Driveway, Class A Crushed 25 TON fr S's''v �� 2315-8275025 Stone 9 2 Arof) % 2401-6745910 Removal Of Sign EACH 10 2416-0100018 Aprons, Concrete, 18 In. Dia. 1 600 = /;eaG' EACH 11 2416-0102230 Apron, Low Clearance Concrete, 2 �� v e �r e� EACH Equivalent Diameter 30 In. 12 2416-1190230 Culvert, Low Clearance Concrete �Pe [3,0G r,y >0a ' J 70 Entrance Pipe, Equivalent Diameter LF 30 In. 13 2435-0140148 Manhole, Storm Sewer, SW-401, 48 1 foc e a• %goo In. EACH 14 2435-0254100 Intake, SW-541 3 1 I:- ` /not) `ir EACH 15 2435-0254200 4 `/ /00 `y% lei/goo 4 - -e PP Intake Extension Unit, SW-542 EACH 16 2435-0254500 1 4 ,S7/ C' `'" Intake, SW-545, LO = 12' EACH FORM OF BID 1of4 CONTRACT NO. 991 Page ? sv4' s-061 17 2435-0600020 Manhole Adjustment, Major 1 EACH 1 Subdrain, Longitudinal, 6 (Shoulder) 18 2502-8212036 2,117 LFsr' ivi In. Dia. I act/ ' In., As Per Plan 4 EACH 300 19 2502-8221006 Subdrain Riser, 6 j1500 `= = 6 EACH Ased 20 2502-8221303 Subdrain Outlet, DR-303 Storm Sewer Gravity Main, Trenched, ..2000D o 452 LF % 21 2503-0114215 Reinforced Concrete Pipe (RCP), Class III InCQ013y ,15 Storm Sewer Gravity Main, Trenched, aidc 230 LF Concrete Pipe 22 2503-0114218 Reinforced (RCP), L/!/»270 2000D (Class III),18 InI� Storm Sewer Pipe Less Than Remove 23 2503-0200036 155 LFJ'ni0`� OrEqual To36In.il�� ?An ill> 47.2 TON 24 2507-6800061 Revetment, Class E 3,311 SY it no ` c Of Pavement 25 2510-6745850 Removal 26 2518-6910000 Safety Closure 51'O 62% 2 EACH aso 13.95 STA � �- /D � s� & Pavement Marking, Painted 27 2527-9263109 %� Waterborne Or Solvent -Based Legend, Preform t' , 1)675 Pre-cut Symbol and 28 2527-9263155 3 EACH tsz Thermoplastic 29 2528-8445110 Traffic Control 1 LS ateRire° 9fl)O 1 LS ?:1e' 300el 30 2533-4980005 Mobilization 636/6 j etv Water Main, Trenched, Ductile Iron 31 2554-0112016 568 LF 10 16 In. Pipe (DIP), ci V J c 1 EACH 32 2554-0210201 Fire Hydrant Assembly0 Fre I%? a= 1 EACH 33 2599-9999005 Removal Of Fire Hydrant Assembly a / /m.; ‘, s` Valve 3 EACH 34 2599-9999005 Install 16 I n Gate (DIP) 303S- . bre e e=ce Fence Gate 1 EACH — 35 2599-9999005 Remove And Reinstall jJ soo coo° = Removal Of Watermain 500 LF Ai 36 2599-9999009 112 SQ ©' 1, bp Special Ditch Control, Wood Excelsior 37 2601-2640350 a Mat `� 31,. -= 2.13 ACRE %575- 38 2601-2634150 Mulching, Wood Cellulose Fiber <� 5 :3 1.46 ACRE /Arc 39 2601-2636043 Seeding And Fertilizing (Rural) flk es-- 0.67 ACRE 4--- 40 2601-2636044 Seeding And Fertilizing (Urban) 6269 316 at .0 y� 1,933 LF / 41 2602-0000020 Silt Fence t a- A`' 199 LF 1/ 42 2602-0000030 Silt Fence For Ditch Checks �) l ., ��� Of Silt Fence Or Silt Fence Removal sue' 43 2602-0000071 2 132 LF For Ditch Checksorf /0 ac RD Maintenance Of Silt Fence Or Silt 44 2602-0000101 2,132 LF c Check Fence For Ditch 00 Stabilized Construction Entrance, EC- 100 LF�er 45 2602-0000150- 303 Open Curb Intake Sediment s'� tin_L' -Throat 46 2602-0000500 46 LF©? Filter EC-602 Maintenance Of Open Curb a. 6� -Throat sy 47 2602-0000510 4 EACH (2 Intake Sediment Filter Curb Intake ev c - Removal Of Open -Throat 48 2602-0000520 4 EACH 5 Sediment Filter020 R J 70e � Control 4 EACH /27S 49 2602-0010010 Mobilizations, Erosion TOTAL B I D 8V3 bs 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 , A the sum of �` Dollars ($ in the form of /?t, LA iL , 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 510,000.00 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 8 - ao ac? 10. The bidder shall list the MBENVBE 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. FORM OF BID CONTRACT NO. 991 3 of Page 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. ° Ct) 14S4tUe4 °CA I CIC Te/e7 cafic,•10) (Name of Bidder) (Date) BY: /-��Title tiffw,i- � Official Address: (Including Zip Code): Pa los rsi (it, s\igle).x/9- set 60 I.R.S. No. r7se 028tpPiol. FORM OF BID CONTRACT NO. 991 Page 4 of 4 NON -COLLUSION AFFIDAVIT OF PRIME BIDDER State of ,� ) County of giii.c/C Hiw )ss OIAtil e Lek , being first duly sworn, deposes and says that: 1 He is (Owner, Partner, Officer -Representative, or Agent) of ns.../;vat , 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, lowa, 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) ket"—est-4-t'l Subscribed and sworn to before me this 177 , 20010. My commission expires X74seI /S gea3 Title '2//t day of I LINDAKSENN 0 COMMISSION NO. 803307 MY COMMISSION EXPIRES 3 e1 r a r3uuue r `taws >✓ 0 WM To he completed by all bidders Par 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). No My company has an office to transact business in Iowa. No My company's office in Iowa is suitable for more than receiving mail, telephone calls, and e-mail. No My company has been conducting business in Iowa for at least 3 years prior to the first request for bids on this project. 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 8 My company has maintained offices in Iowa during the past 3 years at the following addresses: Dates: / / to / / ='-'�' Address: '��t' '<('/ iis-1 CCCity, State, Zip: r tai Y p � Dates: / / to / / Address: City, State, Zip: / / to / / Address: You may attach additional sheet(s) if needed. City, State, Zip: Dates: To be completed by non resident bidders Pa rits 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. Yes I I No You may attach additional sheet(s) if needed. To be completed by all bidders Part 1 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: 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) W.rkshget: Auth.rbcatllon to Transact Busness 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. Yes No n Yes Li No n Yes [a' No �] Yes ri No Yes n No Yes n Yes n Yes No n Yes El/No Yes n Yes My business is currently registered as a contractor with the Iowa Division of Labor. My business is a sole proprietorship and I am an Iowa resident for Iowa income tax purposes. My business is a general partnership or joint venture. More than 50 percent of the general partners or joint venture parties are residents of Iowa for Iowa income tax purposes. 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. 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 lowa 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 fried 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 liabilit 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 lowa, 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: L 0C • B hANTBE BUSH\ESS ENTER?ROSE Ei8UD CONTACT 0NFORiM " TUON FORA/ Ccvt4 bc+Ic✓1. Project: P11 • Letting Date: 4t/PH 20 30 NO MBE/VI/BE SUBCONTRACT RS: If you are NOT using any MBE/WBE subcontractors to complete this project, sign below. Attach a brief explanation as to why subcontracting was not feasible with this project. If any MBE/VVBE subcontractors will be used, please use the bottom portion of this form. Contractor Signature: 1.254:1111.11-r4Crl Date: 5—s'ir - -9 SUBCONTRACTORS APPLIICABLE: You are required, in order for your bid to be considered responsive, to provide the information on this form showing ALL of your MBEIWBE 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 MBEIWBE 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 INFORlillA T flON SEE_OWUNG BIJD.ERUS PR+-03UD fi 3 E/IN E NESS ENTER??'.flS ,_ CONTACTS MB{/ TBE Su:)contracwors I telt Ju5exf gcoils? es DC, Coil) (Form CCO-4) Rev. 06-20-02 Quotes Receivei. Con -tatted. Yes/No 7'.tta' r e 7t9a,10/ y fif Quotation used. in bid Bates ContacteL /3 --)Pge C-/? ev 9l asoesiser Yes/ \ 0 Dollar Amount Proposed to be Subcontractec kiQ-i' i•ea. ht, et. hL dide Akist 42‘d•zi-co G'.. V) `.� L'✓� i Revised February 2003 CONTRACTOR'S IF N y RACTOR'S AFFIRMATIVE ACTION PRGRARIi Check box that applies to party completing program: General Contractor Subcontractor I. Section A to be completed by GENE -,, L CLM v ACTORS only: A. Name of Company Lo dj � 1�rt AddressCompany of Com n Roey, / Glt�ts°')j� Zip312-Y17 pay Telephone Numberfl 7 ) ' r.3 20 p ( ) Federal JD Number (if no Federal ID Number, Owner/President's Social S ecurity Number) _ /1-7---ai'' `"24 N ame of Equal Employment Officer S4e%e q- � N ame of Project y (le tetrea Sirs R� P roject Contract Number 99 Estimated Construction Work Dates e "/ -2o ' / 'r 'h•- Start Finish S ection B to be completed by SUBCONTRACTORS only: B. N ame of General or Prime Contractor N ame of Subcontractor S ubcontractor's Address Zip S ubcontractor's Telephone Number ( S ubcontractor's Federal ID Number (if no Federal ID Number Owner/President's Social Security Number) N ame of Equal Employment Officer C. Remainder of program to be completed by party completing program, either Prime or Subcontractor. 1. The Owners and/or Principals of your company: Ethnic Name Address Position Sex Origin Pa- BOfr 9r/ cictAA Vi 2. Other Areas of interest: If your company has branches or subsidiaries, or if your company is a branch or subsidiary of a parent organization, give the following information: Type of Name Address Affiliation Degree 11. EMPLOYER'S POLICY (Please read carefully.) A. We, the undersigned, recognize that we are morally and legally committed to nondiscrimination in employment. Any person who applies for employment with our company will not be discriminated against because of race, color, creed, sex, national origin, economic status, age, mental or physical handicap. B. The employment policies and practices of the undersigned are to recruit and hire employees without discrimination, and to treat them equally with respect to compensation and opportunities for advancement, including training, upgrading, promotion, and transfer. However, we realize the inequities associated with employment training, upgrading, contracting and subcontracting for minorities and women and we will direct our efforts to correcting any deficiencies to the maximum extent possible. The same will be required of our SUBCONTRACTORS and suppliers. C. We submit this program to assure compliance with Executive Order 11246, as amended, and other subsequent orders that may pertain to equal employment opportunity and merit employment policies, fully • realizing that our qualification and/or merit system should be evaluated and revised, if necessary. D. We agree to put fo � th.., maximum effort to achieve full employment and utilization of ca."±, ;1!. and productivity of all our citizens without regard to race, creei°°����; sex, national origin, economic status, age, and mental or ph �ii (���'cap. (Nam and em the great-' III. AFFIRMATIVE ACTI 619 will give training I residents of Waterloo, Iowa, to A ; (( U;[M'� recognizes B. C. effectrit empl ,� than just a p ;t� SQ619 (Na will, therefore, re-evaluateirmative oppo equal employment o o �''� :re availab'6 q p Y ��% merit, and to actively e "'��f 4 - minorities, women and loca rd to seek emplo ;; • on this basis. (Na following six ('°'' 1 will undertake the ative Action Program: 1. Minority Recruitment and Employment; 2. Local Recruitment and Employment; 3. Disabled Veteran and Vietnam Era Veteran Recruitment and Employment; 4. Handicapped Recruit l,rs:r 4 nd Employment; 5. Female Recruitment r4i.giSir:J7h loyment; and. 6. Training, U gradi • . ,{ t;t( otional Opportunities, will take (Name of whatever step �;' at our total work force has adequate minori y, f i i e �,; = tation. We will utilize the following methods in our recruitment attempts: 1. Local advertising media (newspapers, radio, TV); 2. Community organizations (churches, clubs, schools); 3. Public and private institutions in the area (UNI, Hawkeye Community College); 4. Job Service of Iowa; and 5. Other. D. (Name female, asserted efforts to k max in occupations at the higher levels or skill and responsibility. ill seek qualified minority, r all job categories and will make emale and group representation E. All sources of employment used shall be aware that we are an Equal Employment Opportunity Employer. Labor organizations representing our employees will be notified of our �qual Employment Opportunity Policy and Affirmative ,*ti•• Program. F. Training, upgrading, monitored to ens minority, f G. H. (Name companies Wi same an s e r (Nam':.�?c,%\it; , , ��- Affirma ='•i - • !l' : = �� '•� , inority, female, local contractors and/or suppliers w re ;� unities to negotiate and/or bid on �� g this project: (if none, write "NONE") and transfer activities at all levels will be consideration has been given to qualified oyees. will encourage other d and/or do business, to do the in their efforts. has taken the following 1. 7 'J 2. pJjo»e As a result of the above efforts, we have involved minority, female, and local contractors and/or suppliers in the following areas of subcontracting: (if none, write "NONE") 1. , OLIE 2. (Name of Co Affirmati propos necess repres force. Ciatamir, 50619 will require approved all nonexempt contractors who nd will take whatever steps are ority contractors have adequate d local persons in their total work K. In further accordance hxecutive Order 112 company, realize the L. (Na specific actions relative JMftMiroe ; ', mployment, training, upgrading and promotion and will provide the City of Waterloo with any information relative to same, including activities of our SUBCONTRACTORS and suppliers as necessary or then requested. es and guidelines issued pursuant to ended, we establish the goals for our centages supplied by the City, and we an annual basis. will keep records of M. Parit fi ures for coma �'`- ed in Waterloo are as follows: .� vg �t� N. Minority Parity. (Name of�: Employment Goals: Affirmative Action The definition of Affirmative Action Goals is as follows: "Goals may not be rigid and inflexible quotas which must be met, but must be targets, reasonably attainable by means of applying eve good faith effort to make all aspects of the entire Affirmative Action Program work." For the year 201 , please submit percentage targets for employing minorities and women. If you already have reached your target for hiring minorities and women, please submit that percentage. *Goals for Minorities: Goals for Women: Ok *Your affirmative action goats should be between 1 % and 10% or more for minorities and 1 % and 5% or more for women. Please be advised that the goals or targets are purely your estimation of how many women and minorities your company can reasonably expect to hire in 201 . Note, that none of the goals are rigid or inflexible. They are targets that your company calculates as reasonably attainable. This will help the City in its monitoring procedures as required by City of Waterloo Resolution No. 1984-142(4). We hereby certify that we are in compliance with all City and Federal Affirmative Action Regulations and agree to accept all liability for failure to comply. Respectfully submitted, By: Company Executive 5s.j11 -2D2e By: Date Equal Employment Opportunity Officer Date City of Waterloo Affirmative Action Officer Approved Disapproved Reason: By: Date: 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. 8. We, the undersigned, recognize that we are morally and legally committed to non-discrimination in employment. Any person who applies for employment with our company will not be discriminated against because of race, creed, color, sex, national origin, economic status, age, mental or physical disabilities. (Signed) (Appropriate Official) (title) /7"C-Z2r90 (Date) EQUAL OPPORTUNITY CLAUSE PAGE 2 OF 2 PAGES