HomeMy WebLinkAboutBaker Enterprises Incr
CN— TCJ-4,t3rliS 9, tNIc
E3A1C rRs.
PO Box 277
Waverly, IA 50677
BID SECURITY FOR:
FY 2020 WARP DRIVE R.I.S.E. PROJECT NO.
RM-8155(764)--9D-07, CONTRACT NO 977
CITY OF WATERLOO
715 MULBERRY STREET
WATERLOO, IA 50703
AKEFR
cr-J T 'arms S 1PJC_
PO Box 277
Waverly, IA 50677
ir
BID PROPOSAL FOR:
FY 2020 WARP DRIVE R.I.S.E. PROJECT NO.
RM-8155(764)--9D-07, CONTRACT NO 977
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 are held and firmly bound unto the CITY OF WATERLOO , Iowa, hereinafter called
Five Percent of Bid Amount (5% of bid amount)
"OWNER." In the penal sum
Dollars ($ XXX ) 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 conditioy of this obligation i h daysyuch that
J
whereas the Principal has submitted the accompanying bid dated the of u
, 20 20, for Project No. RM-8155(764)--9D-07 - FY 2020 Warp
Drive R.T.S.F..
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 causpd their corporate seals to be hereto affixed and these presents to be
officers this 2nct dayof July, A.D. 20 20 .
signed by their proper
BID BOND
Baker Enterprises, Inc. (Seal)
Principal
By
(Title)
Granite Re, Inc.
Surety
By
(Seal)
Troy Staples Attorney -in -fact
CONTRACT 977 6 - 1
RM-8155(764)--9D-07
AcKNOWLI� D G[iv I;=,AI C1 OF IP h-11thICEGSA11
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 PRINCS:C'AP. (Pa
State of
)
)
County of )
On this day
nersWup)
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)
State of Loa
County ofrbrQmer
)
)
)
On this
q÷"
day of cJ (A.+B in the Y ear d gD, before me personally come(s)
r
re
the S
z;, aoatiLtisr"
, to me known, who, being duly sworn, deposes and says that he/she is
�° r of the C 42.ar' Ecr\rs seS 1 rC'C�Q �Y�► {
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 )
SUNDA It MEA
cCommission Number 796005
My Commissio Expir
Ma v 5
•
NotaPublic
ACKNOWLEDGMENT OF SURETY
On this 2nd day of July, in the year 2020, before me personally come(s) Troy Staples, Attorneys) -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 as omey(s)-in-Fact
of the said company .ke order.
4
t000000
-.
tar
.dorm llv'"ll�/1l./y✓✓l
TONI L FERRILL
NOTARY PUBLIC - MINNESOTA
My Commsssion Expires Jan. 31, 2022
Notary Public
QJ
•
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 principal 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 resolution 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 ofJanuary, 2020.
STATE OF OKLAHOMA )
) SS:
COUNTY OF OKLAHOMA )
ton, President
f`t: � '&/
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
Notar Public
GRANITE RE, INC.
Cert ficate
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 15, 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 'ssued by the Company in the course of is 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 ;thi$\certificate and affixed the corporate seal of the Corporation this
2nd day of July 2020,
GR0800-1
tv
Kyle P. McDonald, Secretary/Treasurer
OR U1 OF MD OR PROPOSAL
L
F.Y. 21020 Uk I ` RP DREIVI:= 1 .110S UE. PROJ
=,GT V\10. Ra=10156(76floo9Do07
CONTRACT hl 979
CITY OF INATILRLOO, IOWA
Honorable Mayor and City Council
Waterloo, Iowa
Gentlemen:
1. The undersigned, being a QQcpnratJpn existing under the laws of the State of
a Partnership consisting of the following partners:
moo. twee G,44.,ervi 6 S .
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
l=ngineer 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.l';o PROJECT NO. RM-81 bb(764)aa
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:
E.Y.
2020 WARP
DRIVE
R.I.S.E.
PROJECT
NO.
RMem8155(764)=AD=107
CONTRACT
NO. 977
ITEM
NO.
ITEM
UNIT
ELIGIBLE
ELIGIBLE
NON-
TOTAL
EST.
QTY.
UNIT
PRICE
BID
TOTAL
BID
PRICE
2.01
CLEARING
AND
GRUBBING
AC
2
1.2
3.2
$ 1,06. do
t
$ 2 (`i0
f
. vG
2.02
TOPSOIL,
ON
-SITE
CY
1,800
15,200
17,000
$
4. ZC
.-4$ o .
$ ,2
00
e
2.03
EXCAVATION,
CLASS
10
CY
3,500
51,500
55,000
$ Z 7 f
$ IS (I ZS c.oo
.
.
2.04
SUBGRADE
PREPARATION
SY
4,158
4,158
$ 1. So
$ CI z 3 t 00
2.05
SUBBASE,
WARP
DRIVE
6"
MODIFIED,
SY
4,158
`7
$
$ -1.
4,158
6,
Z oZ o0
•
2.06
SUBBASE,
TEMPORARY
4'
MODIFIED,
TURNAROUND
SY
420
420
$ s•
00
$ 2, too.
o0
420
420
$ g oo
$ 3 3 co.
00
2
07
SUBBASE,
STONE
8"
MACADAM
SY
.
I
2
08
SUBGRADE
OVEREXCAVATION
CY
350
350
$ G,
$ ZI L oo o0
00
,
685
685
$ i it, od
$ I
( 3 30.00
2.09
GRANULAR
STABILIZATION
TN
4.01
SANITARY
SEWER
PVC
TRUSS,
GRAVITY"
12
LF
1,177
1,177
$ S •
ao
$ s 2
9�
S. on
TRENCHED,
4.02
SANITARY
SEWER
GRAVITY
DIP,
12"
LF
59
59
$ t l 3, vo
$ `0 (0/ 00
,
MAIN,
TRENCHED,
FORM OF BID
CONTRACT NO 977
RM-6155(764)--9D-07
4-1
SANITARY SEWER SERVICE,
4.03 TRENCHED, PVC, 6"
4.04
4.05
STORM SEWER, TRENCHED,
GASKETED RCP, 15"
4.06
LE
LE
119
120
120 $ 39oa $ %, c,80.00
119 $ 39 . o0
$ 4,`'j(.o0
STORM SEWER, TRENCHED,
GASKETED RCP, 24"
4.07
LE
652
652
$ SZ.00
$ 33, 9D 4,00
STORM SEWER, TRENCHED,
GASKETED RCP, 30"
SUBDRAIN, HDPE, 6"
LF
455
455
$ Z9 S7S.00
LF
2,080
2,080
$ 2 31 9 to. Go
4-.08
SUBDRAIN CLEANOUT
EA
2
2
$ Sob.ct
$ I1 b00. OQ
4.09
PIPE APRON, RCP, 15"
EA
1
1
$ 2,too. 00
$ Z,IbO.aO
4.10
PIPE APRON, RCP, 30"
EA
1
1
$ 2e loo.00
$ Z,9oo.00
5.01
5.02
WATER MAIN, TRENCHED,
DIP, 8"
5.03
5.04
LF
1,158
1,158
$ `-l8.00
$ S S S 141. 00
WATER MAIN, TRENCHED,
DIP, 6"
WATER SERVICE,
TRENCHED, DIP, 8"
LF
32
32
LF
192
192
$ S t-{ . o o
$ i o, 3 i? . oo
FITTING, TEE, 8" x 6"
EA
4
4
$ I, Lob. cio
5.05
FITTING, TEE, 8" x 8"
EA
3
3
$'13S.00
$ ( 3 6 S . 00
5.06
FITTING, REDUCER, 8" x 6"
EA
1
1
$ 20 0o
5.07
5.08
5.09
FITTING, 22.5 DEG BEND, 8"
VALVE, MJ GATE, 6"
VALVE, MJ GATE, 8"
EA
EA
EA
8
4
6
8
4
6
$ 1,3 26. oo
$ Z3 Zo..00
$ 3, 900 .00
$ 7,gso. oc
5.10
5.11
FIRE HYDRANT ASSEMBLY
DEAD END FIRE HYDRANT
ASSEMBLY
EA
EA
4
1
4
1
$ 3, Zoo . oo
$ 1 Z, *do- 00
$ 3I,00,00
6.01
MANHOLE, SW-401, 60"
EA
1
1
$ 3tdo.ou
$ 3, t oo aoo
6.02
6.03
MANHOLE, SW-301, 48"
MANHOLE, SW-301, 60"
EA
EA
3
1
3
1
$ `'Hoo.00
$ 13, 2..00.00
$ gISo.00
6.04
6.05
7.01
7.02
8.01
INTAKE, SW-507
INTAKE, SW-509
PAVEMENT, C-SUD PCC, 9"
PAVEMENT REMOVAL
TEMPORARY TRAFFIC
CONTROL
EA
EA
SY
SY
LS
2
4
3,720
75
1
2
4
3,720
75
1
$ Li oo d.vo
$ S, oSo.00
r
$ 4 Se o
boo. 00
$ Zoe Z oo . 0 0
$ 170, eo y, ao
$ (! S Oo . 00
$ 5 Io.00
9.01
CONVENTIONAL SEEDING,
FERTILIZING, AND
MULCHING
AC
1
31
32
$ I Lf •Zo . oe
$ MS, yc.(o, 00
9.02
9.03
9.04
9.05
FILTER SOCK (INSTALL,
MAINTENANCE,&REMOVAL)
RIP RAP, EROSION STONE
LF
3,000
3,000
o S
SILT FENCE (INSTALL,
MAINTENANCE,&REMOVAL)
9.06
INLET PROTECTION
(INSTALL, MAINTENANCE,&
REMOVAL)
TON
LF
25
2,000
25
2,000
$ J 0.0t
$ 2..05-
$ I, �r so . oo
$ y t00, co
EA
6
6
$ top
$ 1dSo,on
CONSTRUCTION ENTRANCE
(INSTALL, MAINTENANCE, &
REMOVAL)
EA
1
1
$2Soo. oo
$ Z, Soo. o0
FORM OF BID
CONTRACT NO. 977
RM-8155(764)--9D-07
4-2
FENCE REMOVAL, FIELD
9.07 FENCE
LF
1,900
1,900 $ Z , o0
$ 31gOe.00
11.01
MOBILIZATION
LS
$ ZI1/50.00
11.02
MAINTENANCE BOND
LS
$ Ion3.5o.00
$ to13Cos ao
TOTAL
$
9,1-43ci.oa
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 submittingthis 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
p g
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 ce;Pevsce oC A-AA.,3kd
Dollars ($ -F
s /. 6 tid )intheformof
age�
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 $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. Date 4i/zo
10. The bidder shall list the MBI--/WBP subcontractor(s), amount of subcontracts and
bid items on the City of Waterloo Minority and/or Women Business Preabid
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
Kids on this Project are due along with the Non -Collusion Affidavits of All
Su bcontractor(s).
The Contractor shall
"SUBCONTRACTOR RIFQU
prior to approval of contract.
submit information on subcontractors on
ST AND APPROVAL" Form to be provided by City
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. Th
e 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.
g 13.
The Owner reserves the right to select alternates, delete line items, and/or to
reduce prior rior to the award of a contract due to budgetary limitations.
quantities
v`. f er. •pir sees, TA .
(Name of Bidder)
BY:
7/9 fio
(Date)
Title?rsc4
Official Address: (Including rip Code):
ZZD3 E iketamysA
I.R.S No.
:CA So Li
HZ e t5o7`f9Z
FORM OF BID
CONTRACT NO. 977 4 - 4
RM-8155(764)--9D-07
NON -COLLUSION AFFIDAVIT OF PRIMI= BIDDI=R
State of --�--0 �`'
County of 3Pen\�
c1/411-&--b:Aitur
)ss
, being first duly sworn, deposes and says that:
,
'i. He is (Owner, Partner, Officer, I_Re presentativeor Agent) , of ��--
the Bidder that has su mi ted 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 interest, including this
affiant.
(Signed)
4
1 cc"
Title
Subscribed and sworn to before me this1 da y
My commission expires 151 dor) a
NON -COLLUSION AFFIDAVIT -
PRIME
•
uk,k‘d\
INTRITA\tr
2020.
Title
•
o�
z
Huai
•
SHANDA R ZELLE
Commission Number 796005
My Commission Expires
Ma 5,-
-
CONTRACT NO. 977
RM-8155(764) 9D07
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 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 ■ No My business is an active corporation with the Iowa Secretary of State and has paid all fees
required by the Secretary of State, has filed its most recent biennial report, and has not filed
articles of dissolution.
Yes No
Yes
❑Yes E]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 of
withdrawal from the secretary of state nor had its authority revoked.
My business is a limited liability partnership which has filed a statement of qualification in this
state and the statement has not been canceled.
My business is a limited liability partnership which has filed a statement of qualification in a
state other than Iowa, has filed a statement of foreign qualification in Iowa and a statement of
cancellation has not been filed
Yes M 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 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)
IB3kfldor Statu Ii=orcrtn
® be ctRya pDetnel by aDD bidders
Paal
Please answer "Yes" or "No" for each of the following:
Yes LI No
Yes
Yes
Yes
Yes H 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
Mycompany 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
My company has maintained offices in Iowa during the past 3 years at the following addresses:
Dates: / /
ZoG9 to / / act Z-c Address: Z Zo3 6 'rev -rr Ad t .
City, State, Zip: L1 criDuLfer ti 1.-A So L-? 7
Dates: / / to / /
°1 apt o Address: Z L-15 is-o•-ke-t-tit;ts-J ,st-iJQ
City, State, Zip: C ktrAitt k - SZ (3 c
p
Dates: / / to / / Address:
You may attach additional sheet(s) if needed. City, State, Zip:
Part C
To be completed by non-resident bidders
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
Yes �_� No
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.
To be completed by all bidders
You may attach additional sheet(s) if needed.
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: E^. v-tic -c5 , `c:
Signature: Date: 7 Zo
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)
not
Prime Contractor Name:
MBENVBE BUSINESS ENTERPRISE
PRE -BID CONTACT INFORMATION FORM
&Jr.4.k. i-kc. Project: ZQ1 n UJ 4-R P aLlAv r. k �s E. Letting Date: C Z o
NO R/ E/WBE SUE -CONTRACTORS: If you are NOT using any MBE/WBE subcontractors to complete this project, sign bellow. Attach a onef
explanation as to why subcontracting was not feasible with this project. If any MBE/WBE subcontractors wall be used, °lease use the bottom
portion of this form.
Contractor Signature: Title: ti mac' Date: 171 q 2 c�
S CBC*NTRACTORS APPLDCABLE: 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 thus Form showing your MBE/WBE B easiness
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 =XF
R TOON SHOWING BIDER'S P
BE EE BUSX ESS ENTERPRISE CONIT
E-BWC
CT
Quotes
Receive
Quotatisn
used
fin
bfi
MBE/WBE
Dates
1±es/N
' ates
Yes/No
Dollar Amount
proposed
t,r.
Subcontractors
Contacted
Contacted
be Subcontracted
(° lac\
17,0
S <1 $so. co
Tied
± Ntut.- tar 1
e c
(Form CCO-4) Rev. 06-20-02
CONTRACT 977
RM-8155(764)--9D-07
12D-1
Form 730007WP 7-97
Contractor egoLtevow GA. rcr i; f e .mac .
Project#
County
City
R4A giss encos--915-n
%ko.c v. crLit i k
, *ur lot
TARGETED SMALL R(J50NESS (TSB)
PRE -BID CONTACT INFORMATION
(To Be Completed By All Bidders Per The Current Contract Provision)
Page#
In order for your bid to be considered responsive, you are required to provide information on this form showing your Targeted Small Business contacts made with your bid submission. This information is subject to
verification and confirmation.
In the event it is determined that the Targeted Small Business goals are not met, then before awarding the contract, the Contracting Authority will make a determination as to whet her or not the apparent successful low
bidder made good faith efforts to meet the goals.
NOTE: Every effort shall be made to solicit quotes or bids on as many subcontractable items as necessary to achieve the established goals. If a TSB's quote is used in the bid, it is assumed that the firm listed will be used
as a subcontractor.
TABLE OF INFORMATION SHOWING BIDDERS PRE -BID
TARGETED SMALL BUSINESS (TSB) CONTACTS
SUBCONTRACTOR
TSB
DATES
QUOTES
RECEIVED
QUOTATION
USED
IN
BID
CONTACTED
KinCENTAfTFf
YES/
DATES
YES/
DOLLAR
AMT.
PROPOSED
NCl
Tf
RF
CI
IRC
flNTPAfTFrl
NC.
S S g
so
00
t M
-
ZS1 Z
old
5e.r
(0 D
l
GS
,
•
•
Total dollar amount proposed to be subcontracted to TSB on this project $ SS ?So. 00 List
items by name to be subcontracted: at
•o t I tot c .off °l oS"
r