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HomeMy WebLinkAboutVieth Construction CorporationVieth Construction Corporation 6419 Nordic Dr. Cedar Falls, IA 50613 Seated 15< -10 FY D-6)0 W°rF Pr 3"11° e(5 Vieth Construction Corporation 6419 Nordic Dr. Cedar Falls, IA 50613 (1),(3. G for . ipas aminti topiT A 9 �, o C"S.s A BID BOND KNOW ALL MEN BY THESE PRESENTS, that we, Vieth Construction Corporation as Principal, and North American Specialty Insurance Company as Surety are held and firmly bound unto the CITY OF WATERLOO , Iowa, hereinafter called "OWNER." In the penal sum ---Five Percent of the Bid Submitted --- Dollars ($---5%--- ) lawful money of the United States, for the payment of which sum will and truly be made, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally, firmly by these presents. The condition of this obligation is such that whereas the Principal has submitted the accompanying bid dated the 9th day of July 2020 , for F Y 2020 Warp Drive RI S.E Project No. RM-8155(764)--9D-07. ntract 977, Waterloo, IA NOW, THEREFORE, (a) If said Bid shall be rejected, or in the altemate, • (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 6th day of July , A.D. : 2020 (es, 0.1" Agle to trine Crowner Vieth Construction Corporation (Seal) Principal By <27 North Amer' Specialty Insur,'c4 Compact By Attome act �, ioj,- R. Young (Title) SWISS RE CORPORATE SOLUTIONS NORTH AMERICAN SPECIALTY INSURANCE COMPANY WASHINGTON INTERNATIONAL INSURANCE COMPANY WESTPORT INSURANCE CORPORATION GENERAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS, THAT North American Specialty Insurance Company, a corporation duly organized and existing under laws of the State of New Hampshire, and having its principal office in the City of Overland Park, Kansas and Washington International Insurance Company a corporation organized and existing under the laws of the State of New Hampshire and having its principal office in the City of Overland Park, Kansas, and Westport Insurance Corporation, organized under the laws of the State of Missouri, and having its principal office in the City of Overland Park, Kansas each does hereby make, constitute and appoint: JAY D. FREIERMUTH, CRAIG E. HANSEN, BRIAN M. DEIMERLY, SHIRLEY S. BARTENHAGEN, CINDY BENNETT, ANNE CROWNER, TIM McCULLOH„ STACY VENN, DIONE R. YOUNG, and WENDY ANN CASEY JOINTLY OR SEVERALLY Its true and lawful Attorney(s)-in-Fact, to make, execute, seal and deliver, for and on its behalf and as its act and deed, bonds or other writings obligatory in the nature of a bond on behalf of each of said Companies, as surety, on contracts of suretyship as are or may be required or permitted by law, regulation, contract or otherwise, provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the amount of: ONE HUNDRED TWENTY FIVE MILLION ($125,000,000.00) DOLLARS This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors of North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held on March 24, 2000 and Westport Insurance Corporation by written consent of its Executive Committee dated July 18, 2011. "RESOLVED, that any two of the President, any Senior Vice President, any Vice President, any Assistant Vice President, the Secretary or any Assistant Secretary be, and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named in the given Power of Attorney to execute on behalf of the Company bonds, undertakings and all contracts of surety, and that each or any of them hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is FURTHER RESOLVED, that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be binding upon the Company when so affixed and in the future with regard to any bond, undertaking or contract of surety to which it is attached." 4-011111111 C‘ CAAUrY� SEAL TE swnitZ 1973 tv,�"a:, 1001 �����tt t r t u n u i a auiii,� �`"gyp, oN 4, esizo ni SEAL ss E O . lot 1*.965441iivict:RI womutnnttio By en P. Anderson, Senior Vice President of Washington International Insurance Company & Senior Vice President of North American Specialty Insurance Company & Senior Vice President of Westport Insurance Corporation By Mike A. Ito, Senior Vice President of Washington International Insurance Company & Senior Vice President of North American Specialty Insurance Company & Senior Vice President of Westport Insurance Corporation IN WITNESS WHEREOF, North American Specialty Insurance Company, Washington International Insurance Company and Westport Insurance Corporation have caused their official seals to be hereunto affixed, and these presents to be signed by their authorized officers this this 3rd day of November , 20 17 State of Illinois County of Cook On this 3rd day of North American Specialty Insurance Company Washington International Insurance Company Westport Insurance Corporation ss: November , 20 17, before me, a Notary Public personally appeared Steven P. Anderson , Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and Senior Vice President of Westport Insurance Corporation and Michael A. Ito Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and Senior Vice President of Westport Insurance Corporation, personally known to me, who being by me duly sworn, acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the voluntary act and deed of their respective companies. OFFICIAL SEAL M. KENNY Notary Public - State of Illinois My Commission Expires 1 2/04/2021 A\cm v M. Kenny, Notary Public I, Jeffrey Goldberg , the duly elected Vice President and Assistant Secretary of North American Specialty Insurance Company, Washington International Insurance Company and Westport Insurance Corporation do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney given by said North American Specialty Insurance Company, Washington International Insurance Company and Westport Insurance Corporation which is still in full force and effect. IN WITNESS WHEREOF, I have set my hand and affixed the seals of the Companies this 6th day of July , 2020 Jeffrey Goldberg, Vice President & Assistant Secretary of Washington Intemational Insurance Company & North American Specialty Insurance Company & Vice President & Assistant Secretary of Westport Insurance Corporation 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 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.V. 2020 WARP DRIVE R.I.S.E. PROJECT NO. RM-8155(764)--9D-07 CONTRACT NO, 977 TOTAL EST. ITEM NO, 2.01 2.02 ITEM UNIT CLEARING AND GRUBBING TOPSOIL, ON —SITE AC CY 2.03 EXCAVATION, CLASS 10 CY 2.04 2.05 2.06 2.07 2.08 2,09 SUBGRADE PREPARATION SUBBASE, 6' MODIFIED, WARP DRIVE SUBBASE, 4' MODIFIED, TEMPORARY TURNAROUND SUBBASE, 8" MACADAM STONE SUBGRADE OVEREXCAVATION GRANULAR STABILIZATION SY SY EI.I0IBLE 00 3,500 4,158 4,158 SY SY CY TN 4.01 4,02 SANITARY SEWER GRAVITY, LF TRENCHED, PVC TRUSS, 12" SANITARY SEWED GRAVITY MAIN, TRENCHED, DIP, 12" LF 420 NON- ELIGIBLE 1.2 5,200 51,500 Y. 2 17,000 55,000 4,158 4,158 420 UNIT BID PRICE $ $ 4a •� 3 $ •1 a 420 350 685 1,177 59 420 350 685 1,177 59 $ sac TOTAL BID PRICE $ I. Gi©0 $ gtO 1 C S Ii 4-scispa $ 34 3 0 . so $ 3,1./ 5 $ 750 $ a'r 9po $ 1W1 1'> 1 $ I3( gge, FORM OF BID QON"TF ,Cf NO 077 \M 8156(f 4)1)A7 4-j 4.03 SANITARY SEWER PVC, SERVICE, 6' LF 120 720 $t $ l 1J TRENCHED, 4.04 STORM SEWER, TRENCHED, LF 119 119 $ ( 1 $ 1i ��3 GASKETED RCP, 15" STORM SEWER, TRENCHED, 652 $ $ 4� 4.05 GASKETED RCP, 24" LF 652 �( j STORM SEWER, TRENCHED, 455 $ `, $ 4.06 LF 455 (1 ��P� GASKETED RCP, 30" 4.07 SUBDRAIN, HDPE, 6"_ LE 2,080 2,080 $ is $ 2 $ $ 4.08 SUBDRAIN CLEANOUT FA 6 0 f 0' 4.09 PIPE APRON, RCP, 15" EA 1 1 $ -= $ PIPE APRON, RCP, 30" EA 1 1 $ Ir3. i 54 $ „ , 7 o 4.10 MAIN, TRENCHED, $ WATER LE J,158 a„158 $ �' 5.01 � DIP, 8'" 5.02 WATER MAIN, TRENCHED,IF 32 32 $ % $ 628 DIP, 6 WATER SERVICE, LE 1.92 192 $ $ I ��v 5.03 DIP, 8" TRENCHED, 5.04 FITTING, TEE, 8" x 6" EA $ ? $ 726 5.05 FITTING, TEE, 8„ x 8„ EA 3 3 $ $ i 1 1 $ (, e $ I 0s FITTING, REDUCER, 8" x 6" EA 5.06 5.07 FITTING, 22.5 DEG BEND, 8' EA 8 8 $ $ 5.08 VALVE, MJ GATE, 6" EA 4 4 $ / C b $ 5.09 VALVE, MJ GATE, 8" EA 5.10 FIRE HYDRANT ASSEMBLY EA 4 4 $ „�,- $ Q-06 DEAD END FIRE HYDRANT . .. EA ....... .... ... ... . 1 1 $� $ 5.11 ASSEMBLY 1 $ $ `" 6.01 MANHOLE, SW-401, 60"" EA 1 Coe 6.02 MANHOLE, SW-301, 48" EA 3 3 $ %, ? 56 y u 050 6.03 MANHOLE, SW-301, 60" EA 1 1 $ 0 000 $ i 1, o 40 2 $ 4 5 i a $_ ct it, t 6.04 INTAKE, SW-507 EA _ 6.05 INTAKE, SW 509 EA 4 4 $ 6 .. $ c _ 3,720 $ `c, $ )r cioo 75 $ 2' $ 215 7.02 PAVEMENT REMOVAL SY 75 8A1 TEMPORARY CONTROL TRAFFIC LS 3 1 $ $") CONVENTIONAL SEEDING, 1 31 32 $ 41-5 $ .. .. 9,01 FERTILIZING AND AC t MULCHING FILTER SOCK (INSTALL, 3,000 $ ,07 $ S `�� 9.02 LE3,000 t MAINTENANCE,B;REMOVAL) _. mac-_ 9.03 RIP RAP EROSION STONE TON 25 25 $ 3 5 $ - T. s 9.04 SILT MAINTENANCE,&REMOVAL} FENCE (INSTALL, LF 2,000 2,000 $ 1$ ( c INLET PROTECTION 6 $ $ 9.05 (INSTALL, REMOVAL) MAINTENANCE,& EA 6 ( 6c9O ENTRANCE 9.06 CONSTRUCTION (INSTALL, REMOVAL) MAINTENANCE, 8S EA J- 1 $ E 2,"6® $ a' s o FORM OF BID CON F6 ACT NO, 977 RM-6155(704)•--90-07 4-2 9.07 11.01 11.02 FENCE REMOVAL, FIELD FENCE MOBILIZATION MAINTENANCE BOND LE LS LS 11900 a. rAL L3� 1,900 1 bri Zt?jLkeA . $ Sal 40() $ /h,tie,i `(OS 9 7 9. ff.-- isunderstoodquantities set forth are approximate only and subject to Z. It that �I�c. � variation and that af theprice unit bid for the work done shall govern in the actual payment to contractor. , - this bid,bidder understands that the right is reserved by the City 3. in submitting the .• � acceptance of -� Iowa, to reject any or, all bids. If written notice of the acceptanc. of Waterloo,� ed or delivered to the undersigned within thirty (30) this bid is mailed, telegraphed, �� is i? g thereof, or at any time thereafter before this bid days after the opening _ ti .� agreement in the �' rawn the undersigned agrees to execute and deliver an g withdrawn, �� e .� formfurnish the required bond and certificate of the insurance prescribed and � e(10)-� for si nature, and r� after the agreement isresented to hin pgwi�hin � days�� issued. work within ten(10) days ��fier "Notice to Proceed is issustart 1 4. Security in the sum of ---- - -- --- _) in the form Dollars ($ of Ram r\-)\ is submitted herewith in accordance with the INSTRUCTIONS RUCTIONs TO BIDDERS. 5. Attached hereto is a Non --Collusion Affidavit of Prime Contractor. 6. Attached hereto is a Bidder, Status F orris, 7. The bidder prepared is r e pared to submit a financial and experience statement upon request. $, The Prime Contractor and Subcontractor(s) , which have performed an aggregate work the Cityin the current calendar year, are prepared to of $10,000.O0 in for EOC, within � .� 'rication that the or Update and an within ten (10) days of notification submit an MP, bid submitted is lowest and acceptable. g. The bidd er has received the following Addendum or Addenda: :1_ i 0 Addendum No. / Date y the MBE MBE The bidder shall list -MBE subcontractor(s), amount of subcontracts and items the �i�Waterloo Minority and/or Women Business Pre -bid bid on cn�. City of � submitted with this Form of Bid or Proposal. The Contact Information Formsubmitted on r - - Bidder shall submit a list of all other Subcontractor(s) to be apparent �t low i3idc� _3 City of Waterloo .� aterloo b4 5:00 p.m. the business day following the day this Project to thy. FORM OF BID CONTRACT NO. 977 RM-8155(764),9D-O7 4-3 Bids on this Project are due alongwith the Non -Collusion Affidavits of All Subcontractor(s). shalt submit information on The Contractorsubcontractors on "SUBCO NTRACTOR REQUEST AND APPROVAL" Form to be provided by City prior to approval of contract. d this proposal and/or submitted to the Contract The subcontractors listed on p p . Compliance liance Officer cannot be changed except for the following reasons: 1) The Cityof 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 this proposal. Those blanks not applicable la on 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. ViNe-44n Con 54. LILA" n rr 7 I 7 / ;03-6 (Name of Bidder) BY: (Date) Title E�-J€,n Official Address: (IncIuding Zip Code): Vieth Construction Corporation 6419 No'dluflr. Cedar Falls, IA 50613 - I.R.S. No. 63. -m- oS6 96 S7 FORM OF BID CONTRACT NO. 977 4 4 RCM8155(764)- -9D-O7 NON -COLLUSION AFFIDAVIT OF PRIME BIDDER - . State of I County of �Aa � keit*___..) x 1. He is (Owner, Partner, Of hperl ecepresentative r Agent)the Bidder that has submitted the attached Bid; the preparation aration and contents of the attached Bid and of all He is fully informed respecting �- p pertinent circumstances respecting such Bid; 3. Such Bid is genuine and is not a collusive or sham Bid; 4, Neither the said Biddernor any of its officers, partners, owners, agents, representatives, � is � affiant, has in any way colluded, employees, or parties in inter -Est, including t� firm or person conspired, connived or agreed, directly or indirectly, with any other Bidder, 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, directlyor indirectly, sought by agreement or collusion or communicati on or conference with any other Bidder, firm or person to fix the price or prices the attached in Bid or ofother Bidder, or, to fix any overhead, profit or cost any element of the bid pricep or the bid .rice 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 uoted 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 p � , representatives, owners, employees, or parties in interest, including this any of its agents, rep - affiant. )ss being first duly sworn, deposes and says that: ebei (Signe Title Subscribed and sworn to before mo this day of WAX - My commission expires 0 .�````i�%N �ANs ,4;'''� Attu' di :,s 0 IA) 40 I , s� i - CONTRACT NO. 977 7 A NON --COLLUSION AFFIDAVIT 9D07 � EQUAL OPPORTUNITY CLAUSE (As provided in Executive Order No. 11246) All contractors, subcontractors, vendors and suppliers of goods and services doing business with the City and value of said business equals or exceeds ten thousand dollars ($10 000.00) annually agree as follows: 1. The contractors, subcontractor, vendor and supplier of goods and services will not discriminate against any employee or applicant for employment because of race, color, creed, sex, national origin, economic status, age mental or physical handicap, political opinions or affiliations. The contractor, subcontractor, vendor and supplier will develop an Affirmative Action program to ensure that applicants are employed and that employees are treated during employment without regard to their race creed, color, sex national origin, religion, economic status, age, mental or physical disability, political opinions or affiliations. Such actions shall include but not be limited to the following: a. Employment b. Upgrading c. Demotion or Transfer d. Recruitment and Advertising e Layoff or Termination f Rates of Pay or Other Forms of Compensation g. Selection for Training Including Apprenticeship 2. The contractor, subcontractor, vendor and supplier of goods and services will, in all solicitations or advertisements for employees state that all qualified applicants will receive consideration for employment without regard to race, creed, color, sex, national origin, religion, economic status age, mental or physical disabilities, political opinion or affiliations. 3. The contractor, subcontractor, vendor and supplier or his/her collective bargaining representative will send to each labor union or representative of workers which he/she has a collective bargaining agreement or other contract or understanding a notice advising said labor union or workers' representative of the contractor's commitment under this section. 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 CI..AUE CONTRACT 977 8 ' 1 RMP8155(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) .� 'con (Title) 00E61)6 (Date) EQUAL OPPORTUNITY CLAUSE CONTRACT 977 8 - 2 RIW8155(764)t41)407 Wes Ef-Yes jYe s Yes Bidder Status Form To be completed by all bidders Please answer "Yes" or "No" for each of the following: No My company is authorized to transact business in Iowa. on the next page). you determine if our company is authorized, please review the worksheet1 g (To help y 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. ' sidiar of another business entity or my company is a subsidiary of another My company is not a subsidiary y 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. questions above, your company is a nonresident bidder. Please If you answered "No"to one or r`t"iorre complete Parts C and D of this fora. VealSSW Part A [� No El No No Yes No To be completed by resident bidders Part B My company has maintained offices in Iowa during the past 3 years at the fallowing addresses: Vieth Coflstfuctl0hl CorpOrat10n Address: _ 6419 Nordic Dr. Cedar Fail, IA 50613 3 / C /_ 05 to Dates: Dates: / / Dates: / / _ to You may attach additional sheet(s) if needed. To be completed by non resident bidders Address: City, State, Zip: City, State, Zip: Address: City, State, Zi 1. Name of home state or foreign country reported to the Iowa Secretary of State: PartC . state or foreign country offer preferences to resident bidders, resident labor Yes al No M. Does your company's home s s preference g tobidders s orlaborers'' force preferences or any other type of bidder identify each preference offered by your company's home state or foreign country 3. If you answered �_Yes to question 2, lden y and the appropriate legal citation. To be completed by all bidders • document are true and complete to the hest of my knowledge and I know that my I certify that the statements made on this docu bid. failure to provide accurate and truthful information may be a reason to reject��� y You may attach additional sheet(s) if needed. Part D Firm Name: Ve44n e on caL . ( o p. _ Signature: Date: 7fr/cQo the governmental body requesting bids per 875 Iowa Administrative Code You must submit the completed form t� � _ Iowa Labor �or���issioner, Chapter 156. This fora has been approved by the 300-G001 (09-15) 'io-1 orksheet: 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 wr a contractor with the Iowa Division of Labor. [� Yes E- N My business is a sole proprietorship and I ant an Iowa resident for Iowa income tax purposes. Yes RNo 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 f] 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. 0 Yes ffnlo 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 pert( rship which has filed a statement of qualification in this state and the statement has not been canceled, Yes No Yes Yes allo [l Yes El Yes No 0 Yes My business is a limited liability partnership which has filed a statement of qualification in a state other than Iowa, has filed a state rr ent of foreign qualification in Iowa and a statement of cancellation has not been filed, My business is a limited partnership or limited liability limited partnership which has filed a certificate of limited partnership in this state, and has not filed a statement of termination. My business is a limited partnership or a limited liability limited partnership whose certificate of limited partnership is filed in a state other than Iowa, the limited partnership or limited liability limited pannership 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 MBE/WBE BUSINESS ENTERPRISE PRE -BID CONTACT INFORMATION FORM }} d Prime Contractor Name: �In C n_ S � _ F Project; ±Y Ga/� INc) (p p�'• Letting Date: 7)9 / , a NO MBE/WBE SUBCONTRACTORS explanation as to why subcontractl portion of this form, Contractor Signature: If you are NOT using any MBE/WBE subcontractors to complete this project, sign below, Attach a brief as not feasible with this project. If any MBE/WBE subcontractors will be used, please use the/Ibottom Title: .�E r lt^� 4' i Date: `7'y g ri 06 SUBCONTRACTORS APPLICABLE: You are required, in order for your bid to be considered responsive, to provide the information on this form showin J 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 Quotation used in bid MBE/WBE Subcontractors c"a.t.t<.L ._ vr1¢ el, G 4 Ir•�1 (Form CCO-4) Rev, 06-20-02 Dates Contact+ :±JJ Quotes Receis ed Yes/No Dates Contacted 7/-1- Yes/No Dollar Amount Proposed to be Subcontracted 711 CONTRACT 977 RM-S 155(7f 4) -MD-07 Na 12D-1