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HomeMy WebLinkAboutPirc Tobin Constructionel Fite CONSTRUCTION INC. TOr J IN PO Box 160 BID DOCUMENTS: Sealed Bid for Complete Construction FY 2020 Newell Street RISE Project Waterloo, Iowa Alburnett, IA 52202 BID OPENING: 1:00 PM - 0511412020 BID ENCLOSED IF* FRC CONSTRUCTION INC TO J PO Box 160 Alburnett, IA 52202 BID DOCUMENTS: Sealed Bid for Complete Construction FY 2020 Newell Street RISE Project Waterloo, Iowa BID OPENING: 1:00 PM - 05114/2020 lj BID SECURITY'ENCLOSED BID BOND KNOW ALL MEN BY THESE PRESENTS, that we, Pirc-Tobin Construction, Inc. as Principal, and United Fire & Casualty 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 Amount Bid 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 Principal has submitted the accompanying bid dated the 14th day of May , 20 20 , for FY 2020 Newell Street RISE Project • 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 7th day of May , A.D. 20 20 . itne s 7 2- Witness Attorney -in -fact By Pirc-Tobin Construction, Inc. (Seal) Principa,,, B v� United Fire & Casualty Company Surety (Seal) Samantha Spilmatt (Title) • O ▪ 0 • ta.t 4udith A;: Jones• Q Iowa Notariateal Commission number 173041 My.Commission Expires 4/23/2021. • • • ITED FIRE * CASUALTY:COMPANY, :CEDAR. RAP ..UNITED FIRE &; IND.EMMTX:::COMPANY; WEBSTER, ....... .. . ANCIAL PACIFIC.. INSURANCE COMPANY, :RA CERTIFIED COPY:Op. POWER OE -A O. (original on file at Home Office of Company — See Certification) Inquiries: Surety Department 118 Second Ave SE Cedar Rapids, IA 52401 KNOW ALL PERSONS BY THESE:PRESENTS;That United: Ftre Y p Y..&:Casualt Conn. an .; . a coin Oration:duly,or'ganized air .:.:existuig tiinder the anus • ...P or anized . d:: exist under :* - e• laws of . the>' State: Of. Texas• and :Of the State - of:Iowa; United Fire &=::Indeniuity��`Conpaiiy, �: coipoiatioil.<di�t�y g : an ... Ing 1.. n�.... - : maincial Pacific::Insurauce Com -an: a -.co :oratioin d l :or . anized and eXistiiig under--the.::laws of :tlie:Sta:te of Caltfoniia . serene collectively called: :the Companies),::and having their corporate headgttarters.in Cedar. >Rapids, State of Iowa,. does make, constitute an&ap ROBERT h . ' KOLLSMITH, JACQUEL I NE K .: PETERS, DEBORAH ::D D. HAHN, M. LYNN K I MBLE SAMANTHA: S I LMAN,- JENNIFER LUSE, LUKAS SCHRODER, JASON D. SMITH, JAMES M. SMITH, TIMOTHY J. FOLEY, DAVID M. OWEN, BRAD BENGTSON. .AARON COLLINS, LAURI MENEOUGH> EACH::. INDIVIDUALLY eir:'tnie :and :::lawful AttoMe s-in-F'act' with:. polder and authori :hereby. conferred to. sign,:seal and:' execute. ii its behalf a l:.lawful bonds, YO p.. tY �' dent in .: is. arid. other obligatory < inst umei is of similar :i ature tovided` drat no sun le obli ation shall. -exceed :$. 7 000 .000 . tin ... ak g. . �- .. . p g•.. � -' s �: strumerits ��vere�'si ned'b `:the duly tliorized officers of the' Companies ::::.and -to bind.�tiie�-Companies thereby as fitlly-:and to;the:sage e��terit�.asrf u�h.�n ..,.. ..... � .:-:. Y: Y �� ::. p . . and. all of the acts of saidAttothe .pursuant to. the`a thoti hereby i eri andhereb ratified:and :coilfu�n ed ::::: The •Authority hereby granted is' eontinuoirs arid`'sllall remain mn full force. and effect until revoked by` United .Fire Indemnity Company, and Financial Pacific Insurance Company. ,Thts Power of Attorney is made and executed pursuant to and by authority of the following bylaw duly adopted on May 15, 2013,: by> the Boards of: Erecters of U:nited:Fire & Casualty Company, United Fire & Indemnity Company, and Financial Pacific Insurance Company. asp arty Cotnpany, United Fire: sz . "Article VI — Surety Bonds and Undertakings" = :Section 2, Appointment of Attorney -in -Fact. "The President or any Vice President, or any other officer of the Companies may, from time to tune,'. appoint by _written. certificates attorneys -inn -fact to act in behalf of the Companies in the execution of policies of insurance, bonds, undertakings and other obligatory instruments of like nature. >: signature of`ai y.officer authorized hereby, and the Corporate seal, may be affixed by facsimile to any power of attorney or special power of attorney er.c.citification of. either authorized hereby; such signature and seal, when so used, being adopted by the Companies as the original signature of such officer and the original seal of the :Companies,.to be valid and binding upon the Companies with the same force and effect as though manually affixed. Such attorneys -in -fact, subject to the limitations set of .forth ini.tlieir -respective certificates of authority shall have full power to bind the Companies by their signature and execution of any such instruments and to attach tine seal the'Companie.s H ereto. The President or any Vice President, the Board of Directors or any other officer of the Companies may at any time ievoke<•all-power and authority :previously g'fen -tp any attorney -in -fact. CORPORATE :x —•— x= :*-:.SEAL .: • t ,,0 . iis 0, CORPORATE 3 u z r r Z r. 1 • `� SEAL t: 47 sty Late :of Iowa Comity.::of Lunn, ss: "Vise President .::.. • ..:....: ' • On 16t h day of November, • 2017, before me':personal 1 y. came Dennis J • R dhmann to me known, who being by me duly sworn, did depose and say; that he resides in Cedar Rapids, State of Iowa; that he is a Vice President of United Fire ..11111 I I I If1n,.V INS �� •:•• =GOp,POAgt:...0„, 1 LY 22 • 0 = Z.. 1986 'ater. �.: '1'7/0//p 111 I I11&```````` IN WITNESS WHEREOF, the COMPANIES have each caused these presents to.be:signed by: its; vice president and its corporate seal to be hereto affixed this 16t h day of .:November , 201. UNITED FIRE & CASUALTY COMPANY UNITED FIRE & INDEMNITY COMPANY.:.:. FINANCIAL PACIFIC INSURANCE COMPA By: • asualt. :Com an ,:::a.: lice President of:United Fire: ::atldemnl .Company, .and: a Vice::::.President"of::-Financial Pacific ..Insurance Company: .the . : `•.. we nt•. is mows . the: seal affixed to the said �coi�orattpizs -described�.:m and ti�liich:. executed':�:.tlie:. abo.., u�strumet ,••:1 t� he ki .:.. e seal Of said cQrp.orations thaY .. . gas so affix e - p irsuant-:::to autl •orit� :::- iven `ts. the:Boar=d of Direetbrs ol. sald. COI oratioii.s:and that he sl ned`his rporate-:seal ' �tlnat� it� -: insli-un�ient �is-such co Y d pt ::.::. ...: Y•.g ...Y .. �?..: .:. � :tname thereto: pursuant to lnke-::aue.s same to lie. the act -::and deed: of Said: con braions. s. • Bertsch, Assistant S:ecretar.:: of United Fire:.& Casual Com .ail. aiid Assistant ecretary of Financial Pac ific I sti an . Conipany, do hereby certify that I _ I ave compared tlecopy of the: section.of the liylayys a1..idirosolptions of.sald:Corpozatiotis asset fprthrn sai [OM-E OFFICE OF SAID CORPORATION$; and that'the.. sam,e.are correct --trans -flpts Power of Attorriey`ha s not been revoked 'landis now in frill fort e• 'aind effect. • n test this N, CASU,/ll ,• �:' • mil. ibscyibed my name and affixed whereof I have hereui _ day: of. • C�n'ORATE %4 TER '[E� �\ OS bc et, :. `0i!;111lfilpji�j:=:: ���FAc.1NS1.,� f C� ' '. :� .•� : S d ••• I• StiLY: 24? :0 1. . , '14IFORt•'•• �'�.�.. : • ,2 Notary Public :.6 .. whole of:- e•-sal. Originals, :and e .said e corporate seal of the said Corporations • • This paper has a colored background and void pantograph. FORM OF BID OR PROPOSAL FY 2020 NEWELL STREET RISE PRIJEC T RISE PROJECT #RIUih8155(765F9Dm07 CONTRACT NO. 991 CITY OF WATFRLOO, FRLOO, IOWA Honorable Mayor and City Council Waterloo, Iowa Gentlemen: 1. The undersigned, being a Corporation existing under the laws of the State of ere WO•d a Partnership consisting of the following partners: 6vyyvvtftwt , having famili rized (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 S.SO Excavation, Class 10, Roadway And 2102-2710070 Borrow r`�(� 32,.-0 2 2105-8425011 Topsoil, Spread 2,150 CY 1725 pis-/ s87, so 3 2105-8425015 Topsoil, Strip And Stockpile 2,150 CY 45406 flic', '75b.oc 4 2113-0001100 6,260.9 SY 1 •CAS itiOt?30. I ` g 9ro V9 .ot Subgrade Stabilization Material, Pol Grid y mer 5 2115-0100000 Modified Subbase, 6" Thick 1,110 CY S Lis%oo 6 24.8 STA itno,00 $6/,20,0,_60 2123-7450020 Shoulder Finishing, g Earth 197? 2301-1032090 SY S ,y9.— Standard Or Slip Form Portland Cement Concrete Pavement, Class C, 5,712 7 7 2 Durabilit Y�Class 9 In. . � o�Ss 8 Surfacing, Driveway, Class A Crushed 25 TON 0354..00�e7s, ,Stone 2315-8275025 $2ro%oo 9 Of Sign 2 I as. oo 2401-6745910 EACH Removal 10 2416-0100018 Aprons, Concrete, 18 In. Dia. 1 44,00too rAsvo .00lSj000.oZ2 ti,&oo.ct' EACH 11 2416-0102230 Apron, Low Clearance Concrete, 2 EACH Equivalent Diameter 30 In. 12 2416-1190230 Culvert, Low Clearance Concrete Riesza LF 70 Entrance Pipe, Equivalent Diameter 30 In. 4 7, ss�. 13 2435-0140148 Manhole, Storm Sewer, SW-401, 48 1 4000.co #3/000.cc. In. EACH 14 2435-0254100 Intake, SW-541 3 ASA, ,00 047.9St ,co EACH 1/4 4%04 , ap 15 2435 - 0254200 4 ��iBSo. w EACH Intake Extension Unit, SW 54 2 -- 16 2435-0254500 1 $ 91pc ,co Intake, SW-545, LO = 12' EACH Marco FORM OF BID 1 of 4 CONTRACT NO. 991 Page 2435-0600020 Manhole Adjustment, Major 1 aInv .er 17 IrotgSo .cp EACH 18 2502-8212036 Subdrain, Longitudinal, 6 !Too (Shoulder) 2,117 In. Dia. LF �a71 SLl.00 19 2502-8221006 4 t& IS, po 4STO4op Subdrain Riser, 6 In., As Per Plan EACH 20 2502-8221303 6 1iBS.oc 1/ //D. e0 Subdrain Outlet, DR-303 EACH 21 2503-0114215 Storm Sewer Gravity Main, Trenched, 452 �5Z0400 LF Reinforced 2000D (Class Concrete III),15 In Pipe (RCP), �2S,712o& 22 2503-0114218 Storm Sewer Gravity Main, Trenched, 230 ISa oo �i/, 9G0.40 Concrete LF Reinforced 2000D (Class III),18 In Pipe (RCP), 23 2503-0200036 155 �IS.co Less Remove Storm Sewer Pipe Than LF Or Equal To 36 In. t2,3z5t00 24 TON $soco 12,340.00 t/7,8a1cc (.20000 2507-6800061 47 2 Revetment, Class E 25 3,311 SY 7fG.00 2510-6745850 Removal Of Pavement 26 2518-6910000 Safety Closure 2 $/OC.epo EACH 13.95 STA See.Q o iii //G• DO Painted Pavement Marking, 27 2527-9263109 Waterborne Or Solvent -Based 28 Pre-cut Symbol Legend, Preform 3 �S,?,5.00 $ 457S. a 0 Thermoplastic and 2527-9263155 EACH 29 2528-8445110 Traffic Control 1 LS hi Ste . or 01,Sto.00 30 2533-4980005 Mobilization 1 LS if Ci S,too on: (1 S/ 000, or 31 2554-0112016 Water Main, Trenched, Ductile Iron 568 lipase., �S�,g04•eG LF Pipe 16 In. (DIP), 32 2554-0210201 1 gSysz.eo dS25D.D0 Fire Hydrant Assembly EACH 33 2599-9999005 1 $2012_00 %ZGo.00 Removal Of Fire Hydrant Assembly EACH 34 2599-9999005 3 toiroa .00 et/9SOO •DD Install 16 In. Gate Valve EACH (DIP) Ab 7Sp .00 $1/2 750 .00 35 2599-9999005 1 EACH Remove And Reinstall Fence Gate 36 2599-9999009 Watermain 500 $/2oo A �t1coot ,i/,gyg. 0,,Bygoo %/An, 00 oa .oO LF Removal Of 2601-2640350 112 SQ 004•sp Special Ditch Control, Wood Excelsior 37 Mat 38 2601-2634150 2.13 pleice,e0 A wees qo Mulching, Wood Cellulose Fiber ACRE 39 2601-2636043 1.46 ACRE Seeding And Fertilizing (Rural) 1/,3t'O-OO 40 2601-2636044 t2,tcv-cv Seeding And Fertilizing 0.67 ACRE (Urban) 41 2602-0000020 1,933 tiieg *3 )57(o.pS Silt Fence LF 42 2602-0000030 199 I S. ZS ,4QyV 7S Silt Fence For Ditch Checks LF 43 2,132 ta,zse � %Ylo. ZG Or Removal Of Silt Fence Silt Fence LF 2602-0000071 For Ditch Checks 44 2602-0000101 2,132 25� 533. o0 Maintenance Of Silt Fence Or Silt LFto,s Fence For Ditch Check 45 2602-0000150 100 � Stabilized Construction Entrance, EC- LF 303 t3S.Q� 3,Saoc �ss. sr 46 2602-0000500 Open Curb Intake Sediment 46 kits-- -Throat LF Filter, EC-602 2602-0000510 Maintenance Of Open Curb 4 0)?AOG, DG -Throat 47 EACH Intake Sediment Filtero?G,SG 48 2602-0000520 Removal Of Open Curb Intake 4 4r P SS. 00 1�,1,tp .op -Throat EACH Sediment Filter 49 2602-0010010 4 /Si2�to �4ia.co EACH Mobilizations, Erosion Control sfr TOTAL BID 17jt31.94 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 htt rentd- etf b'wt amoux in the form of the sum Dollars ($ 570 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. of 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. �0 Date s'8-20 -#2— .5--/Z-2c 10. The bidder shall list the MBE/WBE subcontractor(s), amount of subcontracts and bid items on the City of Waterloo Minority and/or Women Business Pre -bid Contact Information Form submitted with this Form of Bid or Proposal. The apparent low Bidder shall submit a list of all other Subcontractor(s) to be used on this Project to the City of Waterloo by 5:00 p.m. the business day following the day Bids on this Project are due along with the Non -Collusion Affidavits of All Subcontractor(s). The Contractor shall submit information on subcontractors on "SUBCONTRACTOR REQUEST AND APPROVAL" Form to be provided by City prior to approval of contract. The subcontractors listed on this proposal and/or submitted to the Contract Compliance Officer cannot be changed except for the following reasons: 1) The City of Waterloo does not approve the subcontractors. 2) The subcontractors submit in writing that they cannot fulfill their subcontracts. FORM OF BID CONTRACT NO. 991 3 of 4 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. TcYCsert191 eallatnte79 1.e • (Name of Bidder) BY: Cirali Totahn TitleltR Official Address: (Including Zip Code): b5 (Date) 4 Ztipo dl4 &Lugs ?k. M bAmet%, I.R S. No. %, Iqv m • FORM OF BID CONTRACT NO. 991 Page 4of4 NON -COLLUSION AFFIDAVIT OF PRIME BIDDER State of County of }AIM\ • efiLle •10t9k) 1. A He is 'VenC o, 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; )ss , being first duly sworn, deposes and says that: Owner, Partner, Officer, Representative, or Agent) of ikei,Vin 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. (Signed) precA ig„ Title Subscribed and sworn to before me this 20) day of Title Mycommission expires t �-2Z p CHARLES J ARNOLD NOTARIAL SEAL• IOWA COMMISSION NO 747860 MY COMMISSION EXPIRES, 3di!er Status llorm To be completed by afli lbiodders Part A Please answer "Yes" or "No" for each of the following: s rl No My company is authorized to transact business in Iowa. (To help you determine if your cotnpany is authorized, please review the worksheet on the next page). Yes J ( No My company has an office to transact business in Iowa. Yes No My company's office in Iowa is suitable for more than receiving mail, telephone calls, and e-mail. Yes P1 No My company has been conducting business in Iowa for at least 3 years prior to the first request for bids on this project. Yes [l 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. LI fo • oe completed by resident bidders Part B My company has maintained offices in Iowa during the past 3 years at the following addresses: Dates: / ?.-!. /12a. to / Address: Za 01a, Cillaat fA:________________ City, State, Zip: ktYi'lMk1Ucitj IN\ 17n02-4 Dates: / / to / / Address: City, State, Zip: fDates: / / to / / Address: You may attach additional sheet(s) if needed. City, State, Zip: To be completed by non resident bidders Part C 1. Name of home state or foreign country reported to the Iowa Secretary of State: 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 No • You may attach additional sheet(s) if needed. To be completed by all bidders Part D certify that the statements made on this document are true and complete to the best of my knowledge and I know that my failure to provide accurate and truthful information may be a reason to reject my bid. Firm Name: Signature: 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) 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. ■ Yes ■ No My business is currently registered as a contractor with the Iowa Division of Labor. Yes ❑ No My business is a sole proprietorship and I am an Iowa resident for Iowa income tax purposes. Yes ❑ No ❑Yes ❑ 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. 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 U No My business is a corporation whose articles of incorporation are filed in a state other than Iowa, , the corporation has received a certificate of authority from the Iowa secretary of state has filed its most recent biennial report with the secretary of state, and has neither received a certificate oft withdrawal from the secretary of state nor had its authority revoked. Yes U No My business is a limited liability partnership which has filed a statement of qualification in this state and the statement has not been canceled. Yes [_ No My business is a limited liability partnership which has filed a statement of qualification in a state other than Iowa, has filed a statement of foreign qualification in Iowa and a statement of cancellation has not been filed My business is a limited partnership or limited liability limited partnership which has filed a certificate of limited partnership in this state, and has not filed a statement of termination. ❑ Yes n No My business is a limited partnership or a limited liability limited partnership whose certificate of limited partnership is filed in a state other than Iowa, the limited partnership or limited liability limited partnership has received notification from the Iowa secretary of state that the application for certificate of authority has been approved and no notice of cancellation has been filed by the limited partnership or the limited liability limited partnership. ❑ Yes ❑ No My business is a limited liability company whose certificate of organization is filed in Iowa and has not filed a statement of termination. Yes (1 No Yes U 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) II I3ICIRJR =BW.2 ci Prime Contractor Name: rL -Thin #44/ es E BUSUE\ESS EIN. uER�IRUSE NTACT IINEOKMATE®N FORPJ Project: FY 2020 skewed 5L. Letting Date: s_ /Y 2a • NO MBENVIBE SJBCONTRAC ORS: If you are NOT using any MBE/VVBE 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: ?Ora Seer Date: S�/Y�49 SU CONTRACTORS APPLUCABL : 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/VVBE 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 IINEFOR ATllON SsiOVARNG - Il©nIER°S ?REmBIID Relit E1�\ BE 3LS NESS ENTER°RUSE CONTACTS Quotes �Q'cellvec Quotation used in bid MB1E/W14 7,_ Dates Yes/No Dates SYesNo Dollar Amount Proposed to "c.k ilb u? ,C , CrerfOic2.716.dii SIV20 A i U nk eD 7 0 a Greer ,t (ijotts SN Za Mth ata 4 Oindew airenthen SI Mo iMa- isautol /0 a gifq far..; as, 14044c. arre,. s1 lac " e'rnar/667 /0b (Form CCO-4) Rev. 06-20-02 Form 730007WP 7-97 Contractor Pi; r in Ones/ P rod ect# A � e 51'sr(na) /jr07 TARGETED SMA LL BUSINESS (TSB) PRE -BID CONTACT INFORMATION County 14:t C ka.,7 City (A/'c4fe#f/00 (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 showingTargeted Small Busi verification and confirmation. your g Hess contacts made with your bid submission. This information is subject to In the event it is determined that the Targeted Small Business goals are not met, then before awardingthe contract, the bidder made good faith efforts to meet the goals. Contracting Authority will make a determination as to whet her or not the apparent successful low NOTE: Every effort shall be made to solicit quotes or bids on as many subcontractable items as necessary achieve the established goals. If a TSB's quote is used in the bid, it is assumed that the firm listed will be used • TABLE OF INFORMATION SHOWING BIDDERS PRE -BID TARGETED SMALL BUSINESS (TSB) CONTACTS SUBCONTRACTOR TSB rteofe Welrsel 10:e J el Praeatit 040"nea'4-t3cty,gcaets • 1-4�pp2cr- 44 I # V der O/��L� / 6.44,4e„ 1,�.W raar - Seded n Cur{ t n r.a` EB filebefris 410 s'e tilefstra DATES CONTACTED sit/ to s1'q Zo silk° Total dollar amount proposed to be subcontracted to TSB on this project $c2' 50C• /s List items by name to be subcontracted: l QUOTES RECEIVED YES/ NQ PC! Ai a DATES ffNTAfTFD QUOTATION USED IN BID YES/ ni o q DOLLAR AMT. PROPOSED Tn RF Si iRr.nNTRar.-rFn ao0.aO 0 I*/ loss. AC A2o ,A) 0