HomeMy WebLinkAboutMinturn Inc 144 W. Front St.
P . O . Box 369
Brooklyn , IA 52211
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144 W . Front 51.
P . O . Box 369
Brooklyn , IA 52211
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BID BOND
KNOW ALL MEN BY THESE PRESENTS , that we , Minturn , Inc .
as Principal , and Merchants National Bonding, Inc.
as Surety are held and Firmly bound unto the CITY OF WATERLOO , Iowa , hereinafter called
`OWNER." In the penal sum Five Percent of Amount Bid
Dollars ($ 5 % ) lawful money of the United States, for the payment
of which sum will and truly be made, we bind ourselves, our heirs, executors, administrators, and
successors, jointly and severally, firmly by these presents , The condition of this obligation is such that
whereas the Principal has submitted the accom anying bid dated the 24th day of
September 20 20 , for FY 2021 Sidewalk Repair Assessment Program -
one 10, Contract 1018
NOW, THEREFORE ,
(a) If said Bid shall be rejected , of 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 corate sials to be hereto affixed and these presents to be
signed by their proper officers this 24th day of JCPtember , A . Q. 20 20 .
Minturn, Inc. (Seal) CnavS )
Princinal
By
PA (Title)
_Merchants National Bonding, Inc .(Seal)
W _ u ety-
QM114k ay
Witness Abigai R. Mohr A orney- In-
i
MERCHANTS
BONDING COMPANY,
POWER OF ATTORNEY
Know All Persons By These Presents , that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING , INC . ,
both being corporations of the State of Iowa (herein collectively called the "Companies") do hereby make , constitute and appoint, individually ,
Abigail R Mohr; Enid P Devries ; John R Fay; Kent M Rosenberg ; Mat DeGroote ; Matthew R Fay; Michael L McCoy
their true and lawful Attorney(s)-in -Fact, to sign its name as surety(ies) and to execute , seal and acknowledge any and all bonds , undertakings ,
contracts and other written instruments 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.
This Power-of-Attorney is granted and is signed and sealed by facsimile under and by authority of the following By-Laws adopted by the Board
of Directors of Merchants Bonding Company (Mutual) on April 23 , 2011 and amended August 14 , 2015 and adopted by the Board of Directors
of Merchants National Bonding , Inc. , on October 16 , 2015 .
"The President, Secretary , Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority
to appoint Attorneys-in -Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto , bonds and
undertakings , recognizances , contracts of indemnity and other writings obligatory in the nature thereof."
"The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney
or Certification thereof authorizing the execution and delivery of any bond , undertaking , recognizance , or other suretyship obligations of the
Company, and such signature and seal when so used shall have the same force and effect as though manually fixed . "
In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and aut hority hereby given to the
Attorney-in -Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction
contracts required by the State of Florida Department of Transportation . It is fully understood that consenting to the State of Florida Department
of Transportation making payment of the final estimate to the Contractor and/or its assignee , shall not relieve this surety company of any of
its obligations under its bond .
In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given
to the Attorney-in -Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner-
Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation .
In Witness Whereof, the Companies have caused this instrument to be signed and sealed this 11th day of February 2020
.•```p� .to N44
•. . ' • ANG Cp ' • .
: � • FtPO%,� e0:0 `O�� CPQ �'�9 •• MERCHANTS BONDING COMPANY ( MUTUAL )
:i4y 'GO q> . �;VO 9'�j . 'l� ; MERCHANTS NATIONAL BONDING, INC.
town; . ayJ � - o - d ;
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v'. 2003 ; : y _ 1933 c:
: By
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�• • . . . . • •�a'�. •• d�%;, . . .�f . • 'i,\'�•• President
STATE OF IOWA ••''"• • age % $ `'`� • ' • • . . . • •\
COUNTY OF DALLAS ss .
On this 11th day of February 2020 before me appeared Larry Taylor, to me personally known , who being by me duly sworn
did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING , INC. ; and that the
seals affixed to the foregoing instrument are the Corporate Seals of the Companies ; and that the said instrument was signed and sealed in behalf
of the Companies by authority of their respective Boards of Directors .
AQoFtotA( s POLLY MASON
o v Commission Number 750576A�
My Commission Expires `
• /0 VP • January 07, 2023 Notary Public
(Expiration of notary's commission
does not invalidate this instrument)
I , William Warner, Jr. , Secretary of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING , INC . , do hereby
certify that the above and foregoing is a true and correct copy of the POWER -OF-ATTORNEY executed by said Companies, which is still in full
force and effect and has not been amended or revoked .
In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 24th day of September 2020
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POA 0018 ( 1 /20 )
FORM OF BID OR PROPOSAL
F.Y. 2021 SIDEWALK REPAIR ASSESSMENT PROGRAM — ZONE 10
CONTRACT NO. 1018
CITY OF WATERLOO, IOWA
Honorable Mayor and City Council
Waterloo , Iowa
Gentlemen.
I , The undersigned , being a Corporation existing under the laws of the State of
�D wOL a Partnership consisting of the following partners:
having familiarized (himself) (them Ives) (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 fumish 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. 2021 SIDEWALK REPAIR ASSESSMENT PROGRAM —
ZONE 10, Contract No. 1018, 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. 2021 SIDEWALK REPAIR ASSESSMENT PROGRAM — ZONE 10
' +
CONTRACT NO, 1018
. _ H . .
1 REMOVE & REPLACE PCC SIDEWALK, 4" SF 28 364. 8 i I 0 31 :f 0
2 REMOVE & REPLACE PCC SIDEWALK 5" SF 11667m5 $ 0.
$ 0
3 REMOVE & REPLACE PCC SIDEWALK 6" SF 6474 +5 $ 14 -S
REMOVE & REPLACE PCC SIDEWALK, d
4 CLASS "A" SF 725669 $ 9� $ ( d g 0 S . 50
5 PATCH EACH 6. 0 $ ,Z 00 . 0 $
' 6 CLEAN SIDEWALK EACH 91 .0 i g200 - % $ 17 , 200 .
7 WATER VALVE ADJUSTMENT EACH 8 .0 00 . 2 3 A00 . ° e
8 WATER VALVE CAP EACH 4.0 $ 50 . # D 0 .
9 VAULT TOP REPAIR SF 284.2 $ 5 . ° s i $ y 13 0 '0�
10 DETECTABLE WARNING SURFACE SF 22a0it 3 o
11 SAW CUT LF 38.6 : e, $ 5 A O
12 CURB & GUTTER REPAIR LF 37w01 $ oo 1
o, I 0 0 0
o r! po
14 JOINT SEAL LF 19. 5 0 • v' $00
7 -
16 ITRIM TREE/SHRUBS EACH 44.0.$ Z0 .
FORM OF BID CONTRACT NO. 1018 Page 1 of 3
. `f;{•'• 'Y ,iia;_-. - _
, TOTALIM
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 Y
Dollars ($ J 9 b l in the form of ,
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.
0 . The Prime Contractor and Suboontractor(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.
S. The bidder has received the following Addendum or Addenda :
Addendum No. Date
10 . Theidder shall list the MBENVBE subcontractoramount of subcontracts and
bid items on th b (s} ,
itay Business Pre-b
Contact Information Form submitted with this Form of Bid or Proposal . The
apparent low Bidder shall submit a list of all other Subcontractor(s) to be used on
this Project to the City of Waterloo by 5:00 p . m . the business day following the day
Bids on this Project are due along with the Non -Collusion Affidavits of All
Subcontractor(s) ,
The Contractor shall submit information on subcontractors on
" SUBCONTRACTOR REQUEST AND APPROVAL" Form to be provided by City
prior to approval of contract .
FORM OF BID CONTRACT NO, 1018 Page 2 of 3
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.
V1 ffln(
�ti �zv
(Name of Bidder) (Date)
BY: Title OIL
Official Address: ( including Zip Code):
I L1q VU n i Si o �D3bx3109
_.�
von 1't y S 2Z 11
I . R. S . No . 1 ' to SS 16 I
FORM OF BID CONTRACT NO . 1018 Page 3 of 3
r
1
INFORMATION NEEDED
FOR
IOWA CONSTRUCTION SALES TAX EXEMPTION CERTIFICATE
1 .
CONTRACTOR NAME : I Vl AM X21 b
r
ADDRESS : q N , V VDO 44 7` ✓ b�
(Check One) PRIME SUBCONTRACTOR
' FEDERAL IDN. `'( ) I
PROJECT NAME : ropY ztll S) wo I Paw I r 7kt&
Ir
rcarn - A I
� :
PROJECT CONTRACTI C�
1
DESCRIPTION OF WORK :
❑ Brickwork ❑ Landscaping
❑ Carpentry ❑ Painting
❑ Concrete ❑ Paving
❑ Drywall -Piaster-Insulation ❑ Plumbing
❑ Electrical ❑ Roofing -Siding -Sheet Metal
❑ Excavation/Grading ❑ Windows
❑ Flooring ❑ Wrecking -Demolition
❑ Heavy Construction Other ( Pie ase s ec }I L`
❑ Heating -Ventilating -Air Cond , U r
r
r
r
NO -COLLUSION AFFIDAVIT OF PRIME BIDDER
State of _ � W a )
• 1 , )ss
County of n h
being first duly sworn , deposes and says that:
1 . He Is (CZwner, Partner, Officer. Representative . or Agent) , of f<
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 interest, including this
affiant.
(Signed-) `
Title
bsc"b and sworn to before me this day of
clef ; M ,� , 24,m
Ti
J1 /A
My cammisslan expires /
UIA
MINDY J RHOADS
Commission Number 794952
My Commission Expires
March 08 , 2022
EQUAL. OIC RUN 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 :
I . 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
ent
P
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 contrackWa commitment under this section .
4. 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 PAGE 1 OF 2 PAGES
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 r
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 andlY al committed
�
to nonmfiscrimination 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 Officia }
'PrlS\ O
(Title)
I L4 11 Al n
( Date)
1
EQUAL OPPORTUNITY CLAUSE PAGE 2 OF 2 PAGES '
TITLE VI CIVIL RIGHTS
During the performance of this contract, the contractor (for itself) , its assignees, and
successors in interest (hereinafter referred to as the "contractor") agrees as follows:
1 . Compliance with Regulations: The contractor shall comply with the Regulations
relative to non-discrimination in Federally assisted programs of the DOT Title 49,
Code of Federal Regulations, Part 21 , as they may be amended from time to
time, (hereinafter referred to as the Regulations) , which are herein incorporated
by reference and made a part of this contract.
2 . Nondiscrimination : The contractor, with regard to the work performed by it during
the contract, shall not discriminate on the grounds of race , color, national origin ,
sex, age, or disability in the selection and retention of subcontractors, including
procurement of materials and leases of equipment. The contractor shall not
participate either directly or indirectly in the discrimination prohibited by section
21 . 5 of the Regulations , including employment practices when the contract
covers a program set forth in Appendix B of the Regulations.
3. Solicitations for Subcontracts, Including Procurement of Materials and
Equipment: In all solicitations either by competitive bidding or negotiation made
by the contractor for work to be performed under a subcontract, including
procurement of materials or leases of equipment, each potential subcontractor or
supplier shall be notified by the contractor of the contractor's obligations under
this contract and the Regulations relative to non-discrimination on the grounds of
race, color, national origin , sex, age, or disability.
4. Information and Reports : The contractor shall provide all information and reports
required by the Regulations or directives issued pursuant there to, and shall
allow access to its books, records, accounts, other sources of information , and its
facilities as may be determined by the Contracting Authority, the Iowa DOT , or
FHWA to be pertinent to ascertain compliance with such Regulations, orders and
instructions. Where any information required of a contractor is in the exclusive
possession of another who fails or refuses to furnish this information the
contractor shall so certify to the Contracting Authority, the Iowa DOT, or the
FHWA as appropriate, and shall set forth what efforts it has made to obtain the
information .
5. Sanctions for Noncompliance: In the event of the contractor's noncompliance
with the nondiscrimination provisions of this contract, the Contracting Authority,
the Iowa DOT, or the FHWA shall impose such contract sanctions as they may
determine to be appropriate , including , but not limited to :
a . Withholding of payments to the contractor under the contract until the
b. Cancellation , termination , or suspension of the contract , in whole or in
Part.
6. Incorporation of Provisions : The contractor shall include the provisions of
paragraphs ( 1 ) through (6) in every subcontract, including procurement of
materials and leases of equipment, unless exempt by the Regulations , or
directives issued pursuant thereto . The contractor shall take such action with
respect to any subcontract or procurement as the Contracting Authority, the Iowa
AOT, or the FHWA may direct as a means of enforcing such provisions including
sanctions for non-compliance: Provided , however, that, in the event of a
contractor becomes involved in , or it threatened with , litigation with a
subcontractor or supplier as a result of such direction , the contractor may request
the Contracting Authority or the Iowa DOT to enter into such litigation to protect
the interests of the Contracting Authority or the Iowa DOT; and , in addition, the
contractor may request the United States to enter into such litigation to protect
the interest of the United States.
Bidder Status Form
To be completed by all bidders Part A
Please answer "Yes' or "No" for each of the following :
Yes ❑ 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).
Yes ❑ No My company has an office to transact business In Iowa ,
Yes ❑ No My company's office in Iowa is suitable for more than receiving mail, telephone calls, and e- mail.
Yes ❑ No My company has been conducting business in Iowa for at least 3 years prior to the first request for
bids on this project .
' [ Yes ❑ No My company is not a subsidiary of another business entity or my company is a subsidiary of another
business entity that would qualify as a resident bidder in Iowa .
If you answered "Yes" for each question above , your company qualifies as a resident bidder. Please
complete Parts S 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 / w +/addresses : � �} �
Dates: / _ to ! � " i , " Address: —�� "lJ ' ►
wnV ' `'
City, State , Zip: b 5 7V I
' Dates : / ! to / / Address :
City, State, Zip:
Dates: / / to 1 ! Address:
You may attach additional sheet(s) if needed. City, State , Zip:
To be completed by non -resident bidders Part G
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 , identity each preference offered by your company 's home state or foreign country
and the appropriate legal citation .
You may attach additional sheet(s) r7 needed.
To be completed by all bidders 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: AJ tooA V 0TT41 r
signature , Date: L7
You must submit the completed form to the governmental body requesting bids per 876 Iowa Administrative Code
Chapter 166, This form has been approved by the Iowa Labor Commissioner.
3(19.8(101 (0$- 45)
WorksheetAuthorization 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 .
O 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 (LNo My business is a general partnership or joint venture . More than 50 percent of the general
t( 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 Q No My business is a corporation whose articles of incorporation are flied 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 [ ' No My business is a limited liability partnership which has filed a statement of qualification in this
state and the statement has not been canceler! .
❑ Yes No My business Is a limited liability partnership which has filed a statement of qualification in a
state other than Iowa , has filed a statement of foreign qualification in Iowa and a statement of
cancellation has not been filed .
❑ Yes 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
limiters 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 .
--U
309-6001 (09- 15)
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