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HomeMy WebLinkAboutBaker Enterprises IncEraTcrterajsers, � c PO Box 277 Waverly, IA 50677 7 1 BID PROPOSAL FOR: FY 2020 NEWELL STREET RISE PROJECT RISE PROJECT #RM-8155(765)--9D-07 CITY OF WATERLOO 715 MULBERRY STREET WATERLOO, IA 50703 Ti‘ iII st( 11� 11/2,0 1 A1/413 pet 4;4 N) • ►ABC E n. CNT Mr' fl1SCS, it4C PO Box 277 Waverly, IA 50677 BID SECURITY FOR: FY 2020 NEWELL STREET RISE PROJECT RISE PROJECT #RM-8155(765)--9D-07 CITY OF WATERLOO 715 MULBERRY STREET WATERLOO, IA 50703 BID BOND KNOW ALL MEN BY THESE PRESENTS, that we, Baker Enterprises,_Inc. as Principal, and Granite Re, Inc. as Surety aro held and firmly bound unto the ,_CI OF WAT 00 Iowa, hereinafter called "OWNER." In the penal sum Five Percent of Bid Amount (5% of bid amount) Dollars ($ XXXX ) 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, for , Project NO. RM-8155(765)--9D-07- FY 2020 Newell Street RISE Proiec 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 n 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 thls 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 11 th day of May A.D. 20 20 . Baker Enterprises, Inc. Principal Witness By (Seal) (Title) Granite Re, Inc. Sure roy Staples Attorney -In -fact (Seal) ACKNOWIL GEVi IMT OF EMCEE PL (Thco]llvUthS) State of ) County of On this ) ) day of in the year before me personally come(s) , to me known and known to me to be the person(s) who (is) (are) described in and executed the foregoing instrument and acknowledge(s) to me that he/she executed the same. Notary Public ACKNOWLEDGMENT OF PRINCIPAL (Partnership) State of County of On this ) ) ) day of in the year before me personally come(s) a member of the co -partnership of to me known and known to me to be the person who is described in and executed the foregoing instrument and acknowledges to me that he/she executed the same as for the act and deed of the said co -partnership. Notary Public ACKNOWLEDGMENT OF PRINCIPAL (Corporation) County of 16144/L. State of ctbt'4J& ) ) ) On this I `T day of � �,/ in the year �before me personally come(s) �Gc�t.0 Kama 24), � , to me known, who, being duly sworn, deposes and says that he/she is theYrject YIP of the co C the corporation described in and which executed the foregoing instrument; that he/she knows the seal of the said corporation; the seal affixed to the said instrument is such corporate seal; that it was so affixed by the order of the Board of Directors of said corporation, and that he/she signed his/her name thereto by like order. State of Minnesota ) ) County of Dakota ) tit mxm ,,�� f^,•ram t1/4 r Cam• \Q" $um e,. •• Ar ACC govjav r r r • . 1'• J. r•• v • • r.170 � �� f es Mai • •� re'tt�` ..�� ait,‘"11AE WattirL. otary Public OWLEDGMENT OF SURETY On this llth day of May, in the year 2020, before me personally come(s) Troy Staples, Attorney(s)-in-Fact of GRANITE RE, INC. with whom I am personally acquainted, and who, being by me duly sworn, says that he/she is (are) the Attorney(s)-in-Fact of GRANITE RE, INC. company described in and which executed the within instrument; that he/she know(s) the corporate seal of such company; and that seal affixed to the within instrument is such corporate seal and that it was affixed by order of the Board of Directors of said company, and that he/she signed said instrument a Attorneys) -in - Fact of the said company by like order. (CO TONI L FERRILL 4 NOTARY PUBLIC - MINNESOTA .rs My Commission Expires Jan. 31, 2022 k _es, Notary Public GRANITE RE, INC. GENERAL POWER OF ATTORNEY Know all Men by these Presents: That GRANITE RE INC., a corporation organized and existing under the laws of the State of MINNESOTA and having its pnncipal office at the City of OKLAHOMA CITY in the State of OKLAHOMA does hereby constitute and appoint: JONATHAN PATE; WANDA FRANZ; TOM LAHL; LISA M. FRANCOUR; JENNIFER BOYLES; ZACHARY PATE; TROY STAPLES; NICHOLAS HOCHBAN its true and lawful Attorney-in-Fact(s) for the following purposes, to wit: To sign its name as surety to, and to execute, seal and acknowledge any and all bonds, and to respectively do and perform any and all acts and things set forth in the reso ution of the Board of Directors of the said GRANITE RE, INC. a certified copy of which is hereto annexed and made a part of this Power of Attorney; and the said GRANITE RE, INC. through us, its Board of Directors, hereby ratifies and confirms all and whatsoever the said: JONATHAN PATE; WANDA FRANZ; TOM LAHL; LISA M. FRANCOUR; JENNIFER BOYLES; ZACHARY PATE; TROY STAPLES; NICHOLAS HOCHBAN may lawfully do in the premises by virtue of these presents In Witness Whereof, the said GRANITE RE, INC. has caused this instrument to be sealed with its corporate seal, duly attested by the signatures of its President and Secretary/Treasurer this 3rd day of January, 2020. STATE OF OKLAHOMA ) ) SS: COUNTY OF OKLAHOMA ) 10 : Kenneth D. Whittin on, President Kyle P. McDonald, Treasurer On this 3rd day of January, 2020, before me personally came Kenneth D. Whittington, President of the GRANITE RE, INC. Company and Kyle P. McDonald, Secretary/Treasurer of said Company, with both of whom I am personally acquainted, who being by me severally duly sworn, said that they, the said Kenneth D. Whittington and Kyle P McDonald were respectively the President and the Secretary/Treasurer of GRANITE RE, INC. the corporation described in and which executed the foregoing Power of Attorney; that they each knew the seal of said corporation; that the seal affixed to said Power of Attorney was such corporate seal, that it was so fixed by order of the Board of Directors of said corporation, and that they signed their name thereto by like order as President and Secretary/Treasurer, respectively, of the Company. My Commission Expires: August 8 2021 Commission # 01013257 Notary Public GRANITE RE, INC. Certificate THE UNDERSIGNED, being the duly elected and acting Secretary/Treasurer of Granite Re, Inc., a Minnesota Corporation, HEREBY CERTIFIES that the following resolution is a true and correct excerpt from the July 1 5, 1987, minutes of the meeting of the Board of Directors of Granite Re, Inc. and that said Power of Attorney has not been revoked and is now in full force and effect. "RESOLVED, that the President, any Vice President, the Secretary, and any Assistant Vice President shall each have authority to appoint individuals as attorneys -in --fact or under other appropriate titles with authority to execute on behalf of the company fidelity and surety bonds and other documents of similar character issued by the Company in the course of its business. On any instrument making or evidencing such appointment, the signatures may be affixed by facsimile. On any instrument conferring such authority or on any bond or undertaking of the Company, the seal, or a facsimile thereof may be impressed or affixed or in any other manner reproduced; provided however, that the seal shall not be necessary to the validity of any such instrument or undertaking." IN WITNESS WHEREOF, the undersigned has subscribed this Certificate and affixed the corporate seal of the Corporation this llth day of May 2020 ,ir/fl'Z/ Kyle P. McDonald, Secretary/Treasurer GR0800-1 FORM OF BII-O OR PROPOSAL FY 2020 iJFWi=LL S T RIBE T RIS 7 PROJ1=CT RISE PROJECTIRIVa40155(765)nci9101=1O7 CONTRACT NO. 991 CITY F A r 1= RL©O, IOWA Honorable Mayor and City Council Waterloo, Iowa Gentlemen: 1. The undersigned, being a (Corporation existing under the laws of the State of ar a Partnership consisting of the following partners: Ev..-iitatnerece,s- :irk, 2 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 Price Total Price Unit 8,515 CY 6,00_� i/ `✓ 1 0(�( o nBorrowi 10, Roadway And Excavation, Class 1 2102-2710070 2 2105-8425011 Topsoil, Spread 2,150 CY 6 J CJ 13, i :, . D 3 2105-8425015 Topsoil, Strip And Stockpile 2,150 CY J' c7 Is, S 2_5-1 00 4 2113-0001100 Subgrade Stabilization Material, 6,260.9 SY I -=_, 5-7/0126t it. Polymer Grid 5 2115-0100000 Modified Subbase, 6" Thick 1,110 CY A? , 5?) 9 2! 3 5", co 24.8 STA 6 2123-7450020 -% , '7 c /#7.4 , 00 Shoulder Finishing, Earth SY 9 t ),() 4/ ) al 3,57 I Standard Cement Concrete Or Slip Form Pavement, Portland Class C, 5,712 7 7 2301-1032090 Class 2 Durability, 9 In. Surfacing, Driveway, Class A Crushed 25 TON " ,� 0, () c.? .7 j 7 ,, 00 Stone 8 2315-8275025 Of Sign 2 f ad%) 0 300, 0 0 9 2401-6745910 EACH Removal 10 2416-0100018 Aprons, Concrete, 18 In. Dia. 1 -z7i OO, dog 2.11 00 . no EACH 11 2416-0102230 Apron, Low Clearance Concrete, 2 3(7 5 -; O� 117, 00Equivalent EACH Diameter 30 In. 12 2416-1190230 Culvert, Low Clearance Concrete i7).t, i•_fy/ 1 415-0 00 70 LF Entrance Pipe, Equivalent Diameter 30 In. 13 2435-0140148 Manhole, Storm Sewer, SW-401, 48 1 `�� �� 'do., 0 2,300.•In '? v EACH 14 2435-0254100 Intake, SW-541 3 `l, 300, h O 127400 , 00 EACH 15 2435-0254200 4 *2 'g0. 00 (1 7_.00 , 0° EACH Intake Extension Unit, SW-542 16 2435-0254500 1 `7 `I 0 o, co , 9 0 0 .0 c-) Intake, SW-545, LO = 12' EACH FORM OF BID 1 of 4 CONTRACT NO. 991 Page 17 2435 0600020 Manhole Adjustment, Major 1 EACH 2, l W. 00 77 I t. 00 18 2502-8212036 Subdrain, In. Dia. Longitudinal, (Shoulder) 6 2,117 LF Of 00 C^ j tl Cl a . 00 2502-8221006 Subdrain Riser, 6 In., As Per Plan 4 EACH H7`jb00 i,ciott - 19 20 2502-8221303 Subdrain Outlet, DR-303 6 EACH 2.Z , c0 i' 3 c d 21 2503-0114215 452 LF t50 Z 1 J �- i Storm Sewer Gravity Main Trenched, Reinforced 2000D (Class Concrete III),15 In Pipe (RCP), 22 2503-0114218 Storm Reinforced Sewer Gravity Concrete Pipe Main Trenched, 230 LF 5 5 , CID (2./ 4 5. 0 2000D (Class III),18 In (RCP), 23 2503-0200036 155 LF i 5 ' 4 ti Remove Storm Sewer Pipe Less Than Or Equal To 36 In. f 24 2507-6800061 Revetment, Class E 47.2 TON 5-3, 06 z,voL 6 0 25 2510-6745850 3,311 SY (,, co M C6 Removal Of Pavement 26 2518-6910000 Safety Closure 2 EACH 10c, 00 Z_ i c° Ng 27 2527-9263109 13.95 STA 'P.M i 1 i (C .00 Painted Pavement Marking, Waterborne Or Solvent Based 28 2527-9263155 Pre-cut Symbol and Legend, Preform 3 EACH 5 lc, 0, C ' j 5 / L'S ,o' Thermoplastic 29 2528-8445110 Traffic Control 1 LS 7 , q 5 0, c000 27 `-I ). 000 30 2533-4980005 1 LS 36v, CGD,Gb 7 g, 5 OO. o0 Mobilization 31 2554-0112016 568 LF ►b ,��'iJ i C�oo Water Main, Trenched, Ductile Iron Pipe (DIP), 16 In. 32 2554-0210201 1 EACH 7 Hi 75 O Fire Hydrant Assembly , r-Orbb 00 33 2599-9999005 1 EACH 1,7 5 O 00 1 7 5 00 Removal Of Fire Hydrant Assembly 34 2599-9999005 Install 16 In. Gate Valve (DIP) 3 EACH £, 70,00 7,01(06 00 35 2599-9999005 1 EACH 9 017, 00 H 00, 00 Remove And Reinstall Fence Gate 36 2599-9999009 Removal Of Watermain 500 LF 1 S ; p 0 7 5-00. or) 37 2601 2640350 Speciala{ Ditch Control, Wood Excelsior 112 SQ ) 7, 0b iJ 0i b'L , 00 38 2601-2634150 2.13 ACRE i `/ 6 I2, 00 319 (040,679 Mulching, Wood Cellulose Fiber 39 2601-2636043 1.46 ACRE I; 35-0,00 j'1 `(71. 0 Seeding And Fertilizing (Rural) 40 2601-2636044 0.67 ACRE 7,oOO o0 tf syi, 00 Seeding And Fertilizing (Urban) 41 2602-0000020 Silt Fence 1,933 LF i g5. 3, s- 7 h t� 5 , 42 2602-0000030 Silt Fence For Ditch Checks 199 LF 5, 2-0 ) 3 tj , go 43 2602-0000071 Removal Of Silt Fence Or Silt Fence 2,132 LF ( `i 0 ��' For Ditch Checks 44 2602-0000101 Maintenance Of Silt Fence Or Silt 2,132 Fence For Ditch Check LF ��a -30 '� ` 6 a n 45 2602-0000150 100 LF tic, 00 Dn �' 0.�/ Stabilized Construction Entrance, EC 303� 46 2602-0000500 46 Open Filter, -Throat EC-602 Curb Intake Sediment LF 16—d C © 0 47 2602 0000510 4 EACH 30,00 ov Maintenance Of Open -Throat Curb Intake Sediment Filter 48 2602-0000520 4 EACH S�,C�b Z,2 0, 00 Removal Sediment Of Filter Open -Throat Curb Intake 49 2602-0010010 4 EACH ti L�; ,0 0 ;100. 00 Mobilizations, Erosion Control TOTAL BID 7 l 0, 7 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 sum of C; t 4)sec<A.w4P`d Dollars ($ Am- gza ) in the form of 1,1ct tc,t,c1 , 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 S10,000.00 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 S 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 REUEST 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. sttiNst.v LAtkNeri r•e5- 1 a:%.G , 5/1'1 /ao (Name of Bidder) (Date) BY: Title ? rib ja-c-4° frateal Official Address: (Including Zip Code): ZZo3 E ..at.Lts. qus. a.v 2 c/ ti I.R.S. No. `12, - t Sc. `49 Z FORM OF BID CONTRACT NO. 991 Page 4of4 BID BOND KNOW ALL MEN BY THESE PRESENTS, that we, as Principal, and as Surety are held and firmly bound unto the CITY OF WATERLOO , Iowa, hereinafter called "OWNER " In the penal sum Dollars ($ ) lawful money of the United States, for the payment of which sum will and truly be made, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally, firmly by these presents. The condition of this obligation is such that whereas the Principal has submitted the accompanying bid dated the day of 20 for NOW, THEREFORE, (a) If said Bid shall be rejected, or in the alternate, (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 day of , A D. 20 (Seal) Principal By (Title) (Seal) Witness Surety By Witness Attorney -in -fact NON -COLLUSION AFFIDAVIT OF PRIME BIDDER State of %-n VJ& Cou nty of lL'CV}tL'L. $taLc &au, )ss • , being first duly sworn, deposes and says that: 1. He is (Owner, Partner, Officer (Representatives or Agent) of he Bidder that has submitted the attached Bid; informed C. respecting 2 He is fully the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid; 3 Such Bid is genuine and is not a collusive or sham Bid; 4. Neither the said Bidder nor any of its officers, partners, owners, agents, representatives, employees, or parties in interest, including this affiant, has in any way colluded, conspired, connived or agreed directly or indirectly, with any other Bidder, firm or person to submit a collusive or sham Bid in connection with the Contract for which the attached Bid has been submitted or to refrain from bidding in connection with such Contract, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or conference with any other Bidder, firm or person to fix the price or prices in the attached Bid or of any other Bidder, or, to fix any overhead, profit or cost element of the bid price or the bid price of any other Bidder, or to secure through any collusion, conspiracy, connivance, or unlawful agreement any advantage against the City of Waterloo, Iowa, or any person interested in the Proposed Contract; and 5. The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the Bidder or any of its agents, representatives, owners, employees, or parties in interest, including this affiant. (Signed) as—r-acr ?eb*-fe cat /1itrA.avi.7 c. r Title Subscribed and sworn to before me this I � day of AAA, be W UAW% ICU � My commission expires 3/21j X)2.1 • • Title s.e#.•. , • IsS"11`San /� •V i is: it:: :43) 'z�ry tIt tilt Q�E;poi c�iT,. --finaimint woo 3tidder Stat us For rn To be completed by alll bddders art A Please answer "Yes" or "No" for each of the following: Yes I I No Yes ri No Yes fl No Yes No PS Yes 11 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). My company has an office to transact business in Iowa. My company's office in Iowa is suitable for more than receiving mail, telephone calls, and e-mail. My company has been conducting business in Iowa for at least 3 years prior to the first request for bids on this project. 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 art B My company has maintained offices in Iowa during the past 3 years at the following addresses: Dates: / / to / Dates: / / Zoa1 to / / Z610 Address: 1St-a-1:dt. City, State, Zip: / ?.a Z o Address: Cl tv-t1/4,t,,,i-, TA 5 at 3 r Z2 � E l�ow�.- A-vt City, State, Zip:}vi Sa(=t7 7 Dates: / / to / / Address: You may attach additional sheet(s) if needed. City, State, Zip: To be completed by nonresident 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. 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: I4y- 4 riScs . :Cr! c . Signature: ��! � Date: 5 (1 `i jzb 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 Rt No My business is a sole proprietorship and I am an Iowa resident for Iowa income tax purposes. Yes[2CNo 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. Yes Lf No My business is an active corporation with the Iowa Secretary of State and has paid all fees required by the Secretary of State, has filed its most recent biennial report, and has not filed articles of dissolution. Yes ■ No My business is a corporation whose articles of incorporation are filed in a state other than Iowa, , the corporation has received a certificate of authority from the Iowa secretary of state has filed its most recent biennial report with the secretary of state, and has neither received a certificate ofi withdrawal from the secretary of state nor had its authority revoked. Yes ■ No My business is a limited liability partnership which has filed a statement of qualification in this state and the statement has not been canceled. []Yes RJNo My business is a limited liability partnership which has filed a statement of qualification in a state other than Iowa, has filed a statement of foreign qualification in Iowa and a statement of cancellation has not been filed Yes [l No My business is a limited partnership or limited liability limited partnership which has filed a certificate of limited partnership in this state, and has not filed a statement of termination. Yes 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 ■ No My business is a limited liability company whose certificate of organization is filed in a state other than Iowa, has received a certificate of authority to transact business in Iowa and the certificate has not been revoked or canceled 309-6001 (09 15) Prime Contractor Name: 1M: EI JR = suss ;Ss FNTE1WRUSE 1PRE=3llD CONTACT :NFoRM(A 1T11oN FORM %314.144.s., 6..4upe-i5 cS .c . Niu.,., t S R t 5"Eft44-Lethng :� Project:�- Date. s bLii2e) NO MBE/VW;1E SUBCONTRACTORS: 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/WBE subcontractors will be used, please use the bottom portion of this form. Contractor Signature: Title: se✓b'.e Of tsc Date: $11 `ilZo SUP: n R CTORS �PPUC,� LE: 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 MBEIVVBE 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 IINFORI\AATUON SHOVING 30 / D ERUS PRE -BUD BED I_E BUSUXESS EGATERPRSE CON7ACTS Quotes deceived Quotation uses: t.oi hic[ Subcontractors i m:ww t: Contacte Dates . Yes/No Conta.cte Dates Yes/No Dollar be Amount Subcontractec ?rop o s ed to -Pelted l7 2 Z a . o c) • 5I7Je �- I��s'��- bac. Cor S 1 t t 124 / N..• • 5113 Nit I a ree.4}s .., ( • (Form CCO-4) Rev. 06-20-02 • Form 730007WP 7-97 Contractor e".✓ tS T Prod ect# V►A " g ` S_s (76 se) ' -PM -' 07 TARGETED SMALL BUSINESS (TSB) PRE -BID CONTACT ACT INFORMATION County ��� (4-04) k City U40.44)400 (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 Business your 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 to achieve the established goals. as a subcontractor. g 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 DATES CONTACTED nec14- klut.tearcei b.c. earFi• 0.-z0444^ QUOTES RECEIVED YES/ N! n See 1-7 z �l l l Za ye, l\stts DATES fnNITAfTFf QUOTATION USED IN BID YES/ N! n DOLLAR AMT. PROPOSED Tn RP S! JRMNITRAf.TFn L 1.7 2zZ_ at Total dollar amount proposed to be subcontracted to TSB on this project $ i , ZZ 2. 00 List items by name to be subcontracted: