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BID BOND AMCO Insurance Company
Nationwide Mutual Insurance Company
Allied Property & Casualty Insurance Company
1100 Locust St., Dept 2006 Des Moines, IA 50391 -2006
(866) 387-0457
CONTRACTOR: SURETY :
' Brock Even Construction , LLC Nationwide Mutual Insurance Company
13012 Fox Road 1100 Locust St. , Dept . 2006
Jesup , IA 50648 Des Moines , IA 50391 -2006
OWNER:
City of Waterloo
715 Mulberry Street
Waterloo , IA 50703
BOND AMOUNT : 5 % of Bid Amount Five Percent of Bid Amount
PROJECT :
F . Y . 2021 Sidewalk Repair Assessment Program - Zone 10
k
Contract No . 1018
The Contractor and Surety are bound to the Owner in the amount set forth above, for the payment of which the Contractor
and Surety bind themselves , their heirs, executors, administrators, successors and assigns, jointly and severally, as provided
herein . The conditions of this Bond are such that if the Owner accepts the bid of the Contractor within the time specified in
the bid documents, or within such time period as may be agreed to by the Owner and Contractor, and the Contractor either
( 1 ) enters into a contract with the Owner in accordance with the terms of such bid, and gives such bond or bonds as may be
specified in the bidding or Contract Documents, with a surety admitted in the jurisdiction of the Project and otherwise
acceptable to the Owner, for the faithful performance of such Contract and for the prompt payment of labor and material
furnished in the prosecution thereof: or (2) pays to the Owner the difference, not to exceed the amount of this Bond,
between the amount specified in said bid and such larger amount for which the Owner may in good faith contract with
another party to perform the work covered by said bid , then this obligation shall be null and void, otherwise to remain in
full force and effect. The Surety hereby waives any notice of an agreement between the Owner and Contractor to extend
the time in which the Owner may accept the bid . Waiver of notice by the Surety shall not apply to any extension exceeding
sixty (60 ) days in aggregate beyond the time for acceptance of bids specified in the bid documents , and the Owner and
Contractor shall obtain the Surety ' s consent for an extension beyond sixty (60) days .
If this Bond is issued in connection with a subcontractor ' s bid to a Contractor, the term Contractor in this Bond shall be
deemed to be a Subcontractor and the term Owner shall be deemed to be Contractor.
When this Bond has been furnished to comply with a statutory or other legal requirement in the location of the Project, any
provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefrom and provisions
conforming to such statutory or other legal requirement shall be deemed incorporated herein . When so furnished, the intent
is that this bond shall be construed as a statutory bond and not as a common law bond .
Signed and sealed this 24th day of September, 2020 .
Brock Even Construction , LLC
(Principal) �""" (Seal)
(Witness)
(Title)
Nationwide Mutual Insurance Company0
(Surety) (Seal) SEA] �i
M�-
(Witness) (Title) Jeff Cose , Attorney-in - Fact
This document conforms to American Institute of Architects Document A310, 2010 edition
Power of Attorney
KNOW ALL MEN BY THESE PRESENTS THAT:
Nationwide Mutual Insurance Company, an Ohio corporation
hereinafter referred to severally as the "Company' and collectively as "the Companies" does hereby make, constitute and appoint:
Jeff Cose
each in their individual capacity , its true and lawful attorney-in-fact, with full power and authority to sign, seal , and execute on its behalf any and all bonds and
undertakings , and other obligatory instruments of similar nature, in penalties not exceeding the sum of
Five Hundred Thousand and no/100 -- Dollars $5009000.00
and to bind the Company thereby, as fully and to the same extent as if such instruments were signed by the duly authorized officers of the Company; and all acts
of said Attorney pursuant to the authority given are hereby ratified and confirmed .
This power of attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the board of directors of the Company:
"RESOLVED , that the president, or any vice president be, and each hereby is , authorized and empowered to appoint attorneys4n4act of the Company,
and to authorize them to execute and deliver on behalf of the Company any and all bonds , forms , applications , memorandums , undertakings ,
recognizances , transfers , contracts of indemnity, policies, contracts guaranteeing the fidelity of persons holding positions of public or private trust, and other
writings obligatory in nature that the business of the Company may require ; and to modify or revoke , with or without cause, any such appointment or
authority; provided , however, that the authority granted hereby shall in no way limit the authority of other duly authorized agents to sign and countersign any
of said documents on behalf of the Company. "
"RESOLVED FURTHER, that such attorneys-in-fact shall have full power and authority to execute and deliver any and all such documents and to bind the
Company subject to the terms and limitations of the power of attorney issued to them , and to affix the seal of the Company thereto; provided , however, that
said seal shall not be necessary for the validity of any such documents . "
This power of attorney is signed and sealed under and by the following bylaws duly adopted by the board of directors of the Company,
Execution of instruments. Any vice president, any assistant secretary or any assistant treasurer shall have the power and authority to sign or attest all
approved documents , instruments , contracts , or other papers in connection with the operation of the business of the company in addition to the chairman of
the board , the chief executive officer, president, treasurer or secretary; provided, however, the signature of any of them may be printed , engraved , or
stamped on any approved document, contract, instrument, or other papers of the Company.
IN WITNESS WHEREOF , the Company has caused this instrument to be sealed and duly attested by the signature Of its officer the 2r day of February. 2019,
Antonio C. Albanese , Vice President of Nationwide Mutual Insurance Company
♦�`� ACKNOWLEDGMENT
a�lob iWu
t �sor STATE OF NEW YORK, COUNTY OF NEW YORK: ss
A 7 On this 27"' day of February, 2019 , before me came the above-named officer for the Company
}.SEAL;* aforesaid , to me personally known to be the officer described in and who executed the preceding
� '• ` instrument, and he acknowledged the execution of the same , and being by me duly sworn , deposes
� us � and says , that he is the officer of the Company aforesaid , that the seal affixed hereto is the
k1► corporate seal of said Company, and the said corporate seal and his signature were duly affixed
and subscribed to said instrument by the authority and direction of said Company .
Suzanne C. Delia
Notary puhht, State or New York !I
goafifed in Westchester County
Commission Expires September I6, 2013 Notary Pup;i<
My CMnmimion £rpires
September 16, 2027
CERTIFICATE
i , Laura B . Guy, Assistant Secretary of the Company, do hereby certify that the foregoing is a full , true and correct copy of the original power of attorney issued
by the Company; that the resolution included therein is a true and correct transcript from the minutes of the meetings of the boards of directors and the same has
not been revoked or amended in any manner; that said Antonio C . Albanese was on the date of the execution of the foregoing power of attorney the duly elected
officer of the Company; and the corporate seal and his signature as officer were duly affixed and subscribed to the said instrument by the authority of said board
of directors; and the foregoing power of attorney is still in full force and effect.
IN WITNESS WHEREOF , I have hereunto subscribed my name as Assistant Secretary, and affixed the corporate seal of said Company this . 24th day of
September 2020
Assistant Secretary
BDJ 1 (02- 19)00
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 :
1 . The undersigned , being a Corporation existing under the laws of the State of
7oLiH a Partnership consisting of the following partners :
yroc k CSW. ._ ; ,l ,z ,L . . 4Z6 :
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. 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
BID DESCRIPTION UNIT EST. QTY: UNIT BID . TOTAL BID PRICE
ITEM PRICE
1 REMOVE & REPLACE PCC SIDEWALK , 4" SF 281364 . 8 $ lot ® ' $ 09Y3 (I ' IU'
2 REMOVE & REPLACE PCC SIDEWALK, 5" SF 11667 . 5 $ 1`p
3 REMOVE & REPLACE PCC SIDEWALK, 6" SF 61674 . 5 $ 10, "
REMOVE & REPLACE PCC SIDEWALK,
4 CLASS "A" SF 71256 . 9 $ to °
5 1PATCH EACH 6 . 0 $ V3%0 $ (XI
MINE
6 CLEAN SIDEWALK EACH 91 . 0 $ L5 U $ 22 I 5
7 WATER VALVE ADJUSTMENT EACH 8 . 0 $MENNEN
8 WATER VALVE CAP EACH 4 . 0 $ Z S'O $ \ qkd,
9 VAULT TOP REPAIR SF 284 , 2 $
10 DETECTABLE WARNING SURFACE SF 22 . 0 $ 55 . $ IZ IV3
11 SAW CUT LF 38 . 6 $ 7, U •`� ' $ � \ J
12 CURB & GUTTER REPAIR LF 37 . 0 $ 51a $ Jl)
13 REMOVE & REPLACE 6" PCC W/CURB SF 54 . 5 $ 5.5ONE
14 JOINT SEAL LF I 19e5l $ \ 0 � $ \ Ci\
15 tTR�IMTREE/SHRUBS EACH 44v01 $ )02t � $ \ 3120
FORM OF BID CONTRACT NO , 1018 Page 1 of 3
6'
TOTAL BID
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 S�
Dollars ($ -n?q , 96 1 ) 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 .
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 9/ ) �7 Zc�
10 . The bidder shall list the MBE/WBE subcontractor(s ) , amount of subcontracts and
bid items on the City of Waterloo Minority and/or Women Business Pre - bid
Contact Information Form submitted with this Form of Bid or Proposal . The
apparent low Bidder shall submit a list of all other Subcontractor(s ) to be used on
this Project to the City of Waterloo by 5 : 00 p . m . the business day following the day
Bids on this Project are due along with the Non - Collusion Affidavits of All
Subcontractor(s ) .
The Contractor shall submit information on subcontractors on
" SUBCONTRACTOR 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 .
i
�� c;�k �v .�. (,G.tis �� ew,�,�`�'� ,� LLQ..
( Name of Bidder) ( Date)
BY: l> �C �C FU A Title
Official Address : ( Including Zip Code) :
3
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chc
I . R . S . No . � (�
FORM OF BID CONTRACT NO , 1018 Page 3 of 3
BID BOND
KNOW ALL MEN BY THESE PRESENTS , that we ,
as Principal , and
as Surety are held and firmly bound unto the CITY OF WATERLOO , Iowa , hereinafter called
"OWNER . " In the penal sum
Dollars ($ ) lawful money of the United States, for the payment
of which sum will and truly be made , we bind ourselves , our heirs , executors , administrators, and
successors , jointly and severally, firmly by these presents . The condition of this obligation is such that
whereas the Principal has submitted the accompanying bid dated the day of
20., for
NOW, THEREFORE ,
(a) If said Bid shall be rejected , or in the alternate ,
(b) If said Bid shall be accepted and the Principal shall execute and deliver a contract in the form specified
and shall furnish a bond for his faithful performance of said contract, and for the payment of all persons
performing labor or furnishing materials in connection therewith , and shall in all other respects perform the
agreement created by the acceptance of said Bid ,
Then this obligation shall be void , otherwise the same shall remain in force and effect; it being expressly
understood and agreed that the liability of the Surety for any and all claims hereunder shall , in no event,
exceed the penal amount of this obligation as herein stated .
By virtue of statutory authority, the full amount of this bid bond shall be forfeited to the Owner in liquidation of
damages sustained in the event that the Principal fails to execute the contract and provide the bond as
provided in the specifications or by law.
The Surety, for value received , hereby stipulates and agrees that the obligations of said Surety and its bond
shall be in no way impaired or affected by any extension of the time within which the Owner may accept
such Bid or execute such contract; and said Surety does hereby waive notice of any such extension .
IN WITNESS WHEREOF , the Principal and the Surety, have hereunto set their hands and seals , and such
of them as are corporations , have caused their corporate seals to be hereto affixed and these presents to be
signed by their proper officers this day of A. D . 201
(Seal)
Principal
By
(Title)
Witness Surety (Seal)
By
Witness Attorney-in-fact
NONCOLLUSION AFFIDAVIT OF PRIME BIDDER
State of .10LoC )
l� taz ka�v [ )ss
County of )
k �i being first duly sworn , deposes and says that:
1 . He is (Owner. Partner, Officer, Representative , or Agent) of �� �� CQfl �' Ret
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 )
C.G�ii .z✓'
Title
Subs ribed and sworn to before me this day of
2VQ
Title
My commission expires 202
*0W
KIMBERLY HOFFMANN
11 Commission Number 806424
My Commission Expires
September 12, 2023
Bidder Status Form
To be completed by all bidders Part A
Please answer "Yes" or " No" for each of the following :
'MYes ❑ 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 .
fA 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 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 : / / (3 `Ato / 2 t I Zy Address : a(112
City, State , Zip : 40
Dates : . /. /. to I / Address :
City, State, Zip :
Dates : / / to / / Address :
You may attach additional sheet(s) if needed. City, State , Zip :
To be completed by non - resident bidders Part C
1 . Name of home state or foreign country reported to the Iowa Secretary of State :
2 . Does your company's home state or foreign country offer preferences to resident bidders , resident labor
force preferences or any other type of preference to bidders or laborers? F1 Yes 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 .
You may attach additional sheet(s) if needed.
To be completed by all bidders Part D
certify that the statements made on this document are true and complete to the best of my knowledge and I know that my
failure to provide accurate and truthful information may be a reason to reject my bid .
Firm Name : �C.,�
Signature : �— Date :
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)
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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 tabor.
❑ 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 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
!�`JC withdrawal from the secretary of state nor had its authority revoked .
Yes No My business is a limited liability partnership which has filed a statement of qualification in this
state and the statement has not been canceled .
❑ Yes 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 .
❑ Yeses 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 .
pj 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 KNo 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)