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Home My WebLink AboutPeterson Contractors IncE�ERS�II VAMIKVakra ANC. BOX A REINBECK, IOWA 50669-0155 goo �m rvzozo Wfra OIL • &Ws nb. RM-Slss&vLk) 0-7 Coll 6 r Mernii:3O 1B \IC) ec)KMSPirL, F\I 2t16 Vat) DQ. aolEcer 1\\D 4 RA- SkscoeiA ea an et, of Ntc-TE�1C0 BID BOND KNOW ALL MEN BY THESE PRESENTS, that we, Peterson Contractors, Inc. as Principal, and Travelers Casualty and Surety Company of America 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 Principal has submitted the accompanying bid dated the 9th day of July 2020 , for F.Y. 2020 Warp Drive R.I.S.E Protect No. RM-8155(764)--9D-07, Contract 977, Waterloo, IA 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 matenals 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 22nd day of June , A.D 2020 Petrso$Contractors, Inc. Principal C:N\ar By (4 (-t; N Travelers Ca u ty and°Surety Company of iNn3trApp Suety (Seal) r fl Attor ey-in-fact Anne Crowner', (Title) 3 • Travelers Casualty and Surety Company of America Travelers Casualty and Surety Company St. Paul fire and Marine Insurance Company POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively called the 'Companies"), and that the Companies do hereby make, constitute and appoint Anne Crowner of Waukee Iowa , their true and lawful Attorney -in -Fact to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF, the Companies have caused this instrument to be signed, and their corporate seals to be hereto affixed, this 17th day of January, 2019. f ��sl � �R�Tyr�d HARTFORQ) -et 'a GMT?, q s Y4 State of Connecticut By City of Hartford ss. Robert L. Rane enior Vice President On this the 17th day of January, 2019, before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of said Companies by himself as a duly authorized officer. IN WITNESS WHEREOF, I hereunto set my hand and official seal. My Commission expires the 30th day of June, 2021 lr:rrrr, ef iji + , r it.. � t i t1cTAR Y ke* PIJP-1.M fir it ''w��t Ec K#t Anna P. Nowik, Notary Public This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company, which resolutions are now in full force and effect, reading as follows: RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys -in -Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her; and it is FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary; and it is FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if required) by one or more Attorneys -in -Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys -in -Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I, Kevin E. Hughes, the undersigned, Assistant Secretary of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies, which remains in full force and effect. Dated this 22nc1 day of Jurie 7rt+7. HARTFORD? Pi; r r44.4 sit , 2020 euee Kevin E Hughes, Assistant Secretary To verify the authenticity of this Power of Attorney, please call us at 1-000-421-3880. Please refer to the above -named Attorney -in -Fact and the details of the bond to which this Power of Attorney is attached, FORM OF BID OR PROPOSAL F.Y. 2020 WARP DRIVE R.I.S.E. PROJECT NO. RM-8155(764)--9D-07 CONTRACT NO. 979 CITY OF WATERLOO, IOWA Honorable Mayor and City Council Waterloo, Iowa Gentlemen: 1. The undersigned, being a Corporation existing under the laws of the State of TT...a - , 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 F.Y. 2020 WARP DRIVE R.I.S.E. PROJECT NO. RM-8155(764)-- 9D-07, CONTRACT NO. 977, all in accordance with the above -listed documents and for the unit prices for work in place for the following items and quantities: F.Y. 2020 WARP DRIVE R.I.S.E. CONTRACT PROJECT NO. 977 NO. RM-8155(764)--9D-07 ITEM N0. ITEM UNIT ELIGIBLE NON- ELIGIBLE TOTAL QN UNIT PRICE BID TOTAL BID PRICE 2.01 CLEARING AND GRUBBING AC 2 1.2 3.2 $ 41 e- $ ,sZ/ & c� CY 1,800 15,200 17,000 $ 4,35 $ 93,9co,- 2.02 TOPSOIL, ON -SITE — $ 10 CY 3,500 51,500 55,000 $ �� 7�(, 2.03 EXCAVATION, CLASS n SY 4,158 4,158 $ I r $ 4/ 2.04 SUBGRADE PREPARATION C?. SUBBASE, 6' MODIFIED, St 4,158 4,158 $ $ � 2.05 WARP DRIVE SY 67 2:7i c2%/I� SUBBASE, 4' MODIFIED, 420 $ to $ 2.06 SY 420 93Z TEMPORARY TURNAROUND' 2.07 8" MACADAM SY SY 420 420 $ $ 4 STONESUBBA ` SUBGRADE $ I $ 2 08 CY 350 350 a G' OVEREXCAVATION b2 ' 2.09 GRANULAR STABILIZATION TN 685 685 $ (90 tP $ 131700 `� - SANITARY SEWER GRAVITY,LF 1,177 1,177 $ G,/� $ 4.01 TRENCHED, PVC TRUSS, 12 I I-�' t r7(c I J c� 4.02 SANITARY SEWER GRAVITY LF 59 59 $ i Ce0t $ ggijo ..... t MAIN, TRENCHED, DIP, 12" FORM OF BID CONTRACT NO 977 RM-8155(764)--9D-07 4-1 4.03 SANITARY TRENCHED, SEWER PVC SERVICE, 6" LF 120 120 $ o , $ 4.04 STORM GASKETED SEWER, RCP, TRENCHED, 15" LF 119 119 a $ 4 $ q 570 4.05 STORM GASKETED SEWER, RCP, TRENCHED, 24" LF 652 652 $ $ ,371 57 Ito `1 ' ' 4.06 STORM GASKETED SEWER, RCP, TRENCHED, 30"r LF 455 455 $ a $ G�f�Q �� 4.07 SUBDRAIN, HDPE, 6" LF 2,080 2,080 $ C : $ is,, 7 20 s 4.08 SUBDRAIN CLEANOUT EA 2 2 $ $ j 70 3sO, 4.09 PIPE APRON, RCP, 15" EA 1 1 $ M $ / / , 4.10 PIPE APRON, RCP, 30" EA 1 1 $ / - , $ / 300 o 5.01 WATER DIP, 8" MAIN, TRENCHED, LF 1,158 1,158 $ �/ $ 91a e,igzf- 5.02 WATER DIP, 6 MAIN, TRENCHED, LF 32 32 $ $ f� %" /72 5.03 WATER TRENCHED, SERVICE, DIP, 8" LF 192 192 $ p,Ae�' $ C� go t�" 1z T C� 5.04 FITTING, TEE, 8" x 6" EA 4 4 $ 415 $ / 7 o0 •� 5.05 FITTING, TEE, 8" x 8" EA 3 3 $ i.k , $ / 3Sf5 •� 5.06 FITTING, REDUCER, 8" x 6" EA 1 1 $3CSOe $ 00: 5.07 FITTING, 22.5 DEG BEND, 8" EA 8 8 $ 315 $ 7..0 s� 5.08 VALVE, MJ GATE, 6" EA 4 4 $ 11C0t $ (gc 5.09 VALVE, MJ GATE, 8" EA 6 6 $ (q , $ 01105 T 5.10 FIRE HYDRANT ASSEMBLY EA 4 4 $ ® $ fil 7( .- 5.11 DEAD END FIRE HYDRANT EA 1 1 $: $ 5 i® 6.01 MANHOLE, SW-401, 60" EA 1 1 _ $ $ 32406 '®4_ (3200' $ COO 00 rf , $ e- 6.02 MANHOLE, SW-301, 48" EA 3 3 /CWOC) 6.03 MANHOLE, SW-301, 60" EA 1 1 $ (Z,3 T $ /7, 30 i 6.04 INTAKE, SW-507 EA 2 2 $ $ /L%lico r 6106 T 6.05 INTAKE, SW-509 EA 4 4 $ (0500 $ 2tI c 7.01 PAVEMENT, C-SUD PCC, 9" SY 3,720 3,720 y $ tic- $ f1" %f gal 7.02 PAVEMENT REMOVAL SY 75 75 $ / Z ` $ 900 r 8.01 TEMPORARY TRAFFIC LS 1 1 $ 2&5O,.r $ 2.8 Sb CONVENTIONAL SEEDING, $ i ZOO ,� $ goo 9.01 FERTILIZING AND AC 1 31 32 t 3g, M MULCHING 9.02 FILTER SOCK (INSTALL &REMOVAL) LF 3,000 3,000 $� j' $ �- 9.03 RIP RAP, EROSION STONE TON 25 25 $ /k,,--- $ /1 5-6 (T 9.04 SILT FENCE (INSTALL LF 2,000 2,000 $� $ s I 9.05 INLET (INSTALL, PROTECTION MAINTENANCE,& EA 6 6 $ 1501 $ �j(�C3 V 9.06 CONSTRUCTION (INSTALL, REMOVAL) MAINTENANCE, ENTRANCE & EA 1 1 $ ( ` SW W FORM OF BID CONTRACT NO 977 RM-8155(764)--9D-07 4-2 FENCE REMOVAL, FIELD 9.07 FENCE LF 1,900 1,900 $ $ zs 0 % 11.01 MOBILIZATION LS 1 1 $ tat, $ l 701060 e 11,02 MAINTENANCE BOND LS 1 $ 04 $ 6660 TOTAL BID $ 1, /54, 95/. s2 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. Security in the sum of 0 Dollars ($ crF f ) in the form of 13f1) i+ 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. The bidder is prepared to submit a financial and experience statement upon request. 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. 1 Date 2 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 FORM OF BID CONTRACT NO 977 4 - 3 RM-8155(764)--9D-07 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. 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. (Name of Bidder) -Nria-Acv. CT' [26 ZO (Date) Title �s7 7M n2. / Official Address: (Including Zip Code): 8/0( kACtedk- I.R.S. No. FORM OF BID CONTRACT NO 977 4 - 4 RM-8155(764)--9D-07 INFORMATION NEEDED FOR IOWA CONSTRUCTION SALES TAX EXEMPTION CERTIFICATE CONTRACTOR NAME: ETE.tS ADDRESS: ) 0 (i 8 g,el./rTBECK_ �a � ST (Qfa9 (Check One) PRIME FEDERAL ID#• I42.O9 2. Its 55 4 P ROJECT NAME: 202.0 P ROJECT CONTRACT NO.: DESCRIPTION OF WORK: O Brickwork Carpentry Concrete O Drywall -Plaster -Insulation ❑ Electrical Wxcavation/Grading ❑ Flooring WitHeavy Construction Heating -Ventilating -Air Cond ■ ■ SUBCONTRACTOR ■ Landscaping Painting ❑ Paving ❑ Plumbing ❑ Roofing -Siding -Sheet Metal Windows Wreck ng-Demolition O Other (Please specify) ■ ■ INFORMATION FOR SALES TAX EXEMPTION CONTRACT 977 RM-8155(764)--9D-07 5-1 NON -COLLUSION AFFIDAVIT OF PRIME BIDDER State of IDLO n County of eI R U NDY Mutt oh(en )ss , being first duly sworn, deposes and says that: 1. He is (Owner, Partner, Office ,-epresentative or Agent) of ire+ I 0 n Cohtrot t rs Int. , the Bidder that has submitted the attached Bid; 2. He is fully informed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid; 3. Such Bid is genuine and is not a collusive or sham Bid; 4. Neither the said Bidder nor any of its officers, partners, owners, agents, representatives, employees, or parties in interest, including this affiant, has in any way colluded, conspired, connived or agreed directly or indirectly, with any other Bidder, firm or person to submit a collusive or sham Bid in connection with the Contract for which the attached Bid has been submitted or to refrain from bidding in connection with such Contract, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or conference with any other Bidder, firm or person to fix the price or prices in the attached Bid or of any other Bidder or, to fix any overhead, profit or cost element of the bid price or the bid price of any other Bidder, or to secure through any collusion, conspiracy, connivance, or unlawful agreement any advantage against the City of Waterloo, Iowa, or any person interested in the Proposed Contract; and 5. The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the Bidder or any of its agents, representatives, owners, employees, or parties in intere , including this affiant. (Signed) Pr bJ Ct Man Title Subscribed and sworn to before me this lt) day of ‘QIA 113 {2LUr My commission expires i NON -COLLUSION AFFIDAVIT - PRIME RM-8155(764)-9D07 j22 ow JENNIFER R WISSLER Commission Number 761292 My Commission Expires January 04, 2022 , 2020. A66 -, 7k-eabu f e' Title CONTRACT NO. 977 7 - 1 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 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 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. 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 CONTRACT 977 8 - 1 RM-8155(764)--9D-07 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) r (Title) 7/7 /2r)2C: (D te) EQUAL OPPORTUNITY CLAUSE CONTRACT 977 8 - 2 RM-8155(764)--9D-07 Bidder Status Form To be completed by all bidders Please answer "Yes" or "No" for each of the following: 26.es ❑ No 0/Yes ReYes Er -Yes ❑ No ❑ No ❑ No [✓'Yes ❑ No Part A 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 Part B My company has maintained offices in Iowa during the past 3 years at the following addresses: Dates: II- / ZZ- / S to -� Address: It old-t' -e•Cut S* City, State, Zip• t' iv, k it ' (D(09 Dates: Dates: to / You may attach additional sheet(s) if needed. Address: City, State, Zip: Address City, State, Zip• To be completed by non-resident bidders 1. Name of home state or foreign country reported to the Iowa Secretary of State: Part C 2 Does your company's home state or foreign country offer preferences to bidders who are residents? 0 Yes ❑ No 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. To be completed by all bidders You may attach additional sheet(s) if needed. Part D I certify that the statements made on this document are true and complete to the best of my knowledge and I know that my failure to provide accurate and truthful information may be a reason to reject my bid. Firm Name: i'f Signature: t 0 - P ' td.e-i" Date: ) 62 ( 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 02-14 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 Yes QeNo ❑ Yes E No Qf Yes 0 No El Yes ErNo ■ 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 Iowa secretary of state has filed its most recent biennial report with the secretary of state, and has neither received a certificate of withdrawal from the secretary of state nor had its authority revoked. Yes [i'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. 0 Yes Q-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. Yes acto 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 jNo ❑ Yes 2'No ❑ Yes [✓]'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. My business is a limited liability company whose certificate of organization is filed in Iowa and has not filed a statement of termination. My business is a limited liability company whose certificate of organization is filed in a state other than Iowa, has received a certificate of authority to transact business in Iowa and the certificate has not been revoked or canceled 309-6001 02-14 Form 730007WP 7-97 Contractor ePACISCSIA CS.:.:.-i Project# County City 04.ke,kat, TARGETED SMALL BUSINESS (TSB) PRE -BID CONTACT INFORMATION (To Be Completed By All Bidders Per The Current Contract Provision) Page# In order for your bid to be considered responsive, you are required to provide information on this form showing your Targeted Small Business contacts made with your bid submission. This information is subject to verification and confirmation. In the event it is determined that the Targeted Small Business goals are not met, then before awarding the contract, the Contracting Authority will make a determination as to whet her or not the apparent successful low bidder made good faith efforts to meet the goals. NOTE: Every effort shall be made to solicit quotes or bids on as many subcontractable items as necessary to achieve the established goals. If a TSB's quote is used in the bid, it is assumed that the firm listed will be used as a subcontractor. TABLE OF INFORMATION SHOWING BIDDERS PRE -BID SUBCONTRACTOR TSB DATES QUOTES RECEIVED QUOTATION USED IN BID YES/ Nrl DATES rnNTAM' Fll YES/ Nn DOLLAR AMT. PROPOSED in RF RI IRr:r1NTRACTFn CONTACTED 1®� ✓ ✓ JLI--b 7/8 7 1 0D b b C CO‘re .1%7 1(1 NO Total dollar amount proposed to be subcontracted to TSB on this project $ List items by name to be subcontracted: P rime Contractor Name. MBE/WBE BUSINESS ENTERPRISE E-BID CONTACT INFORM • TION FORM Project: bail tr. Letting Date: licklitOZO N O MBE/WBE 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: C31741 Date: 7 2�® S UBCONTRACTORS APPLICABLE: You are required, in order for your bid to be considered responsive, to provide the information on this form showing ALL of your MBE/WBE subcontractor contacts made for your bid submission. This information is subject to verification. Any questions should be directed to Contract Compliance Office 319-291-4429. You are required, in order for your bid to be considered responsive, to provide the information on this Form showing your MBE/WBE Business Enterprise contacts made prior to your bid submission. This information is subject to verifications and confirmation. If you are unable to identify MBE/WBE firms to perform portions of the work, please contact Rudy Jones, Contract Compliance Officer, for assistance at (319) 291-4429 In the event it is determined that the MBE/WBE Business Enterprise goals are not met, then before awarding the contract the City of Waterloo will make a determination as to whether or not the apparent successful low bidder made good faith efforts to meet the goals. TABLE OF INFORMATION SHOWING BIDDER'S PRE -BID MBE/WBE BUSINESS ENTERPRISE CONTACT Quotes Received Quotation used in bid Subcontractors MBE/WBE Dates Contacted Yes/No Dates Contacted Yes/No Dollar Proposed to Amount be Subcontracted cE �� Nee ils KO 6 71, -� (Form CCO-4) Rev. 06-20-02 CONTRACT 977 RM-8155(764)--9D-07 12D - 1 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. 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. (Name of Bidder) C. 1' /zaao (Date) Title er r7Nt Official Address: (Including Zip Code): 104 it ACKt tktaa Ze1 ctC. , 4 • Cefa9 I.R.S. No. 112.' d921 (Q5 4 �PM FORM OF BID CONTRACT NO 977 4 - 4 RM-8155(764)--9D-07