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HomeMy WebLinkAboutWRH, Inc.• WPM, Inc. WRH Inc. P.0 Box 256 Amana IA, 52203 Bid Security FY 2021 SANITARY SEWER GATEWELL REPAIRS - PHASE I, CONTRACT NO. 951 City of Waterloo at City Hall 715 Mulberry Street, Waterloo, Iowa 50703 CITY WEITERI is CITY CLERKS PliFFICE r—''-_d it Cr..) 11 2021PIviL2. L : a WRH, Inc. WRH Inc. P.0 Box 256 Amana IA, 52203 Official Bid FY 2021 SANITARY SEWER GATEWELL REPAIRS - PHASE I, CONTRACT NO. 951 City of Waterloo at City Hall 715 Mulberry Street, Waterloo, Iowa 50703 CITY. ' WA 8 ERLOr CITY CLERKS OFFICE al 11 2021 PHI : + n 16 IMP IMP BID BOND KNOW ALL MEN BY THESE PRESENTS, that we, WRH, Inc. as Principal, and Merchants Bonding Company (Mutual) 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 11 th day of February 2021 , for FY 2021 Sanitary Sewer Gatewell Repairs, Phase 1, City of Waterloo, IA; Contract No. 951 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 fumish 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 3rd clay of February , A.D. ' 2021 By WRH, Inc. (Seal) Principal R -C Q SWAP&. Act Paa41 o sr (Title) Merchants ,bonding Company,(Mutual) urety By Attor y-in feet Dione R. Young (Seal) ERC TS 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, Dione R. Young 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 consenti ng 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 5th day of March , 2020 •'Q�`•eU.. •90 `o coR R4> 02 2 %i t• 2003 1'* odd ; ' STATE OF IOWA •,**'"""`'•*� COUNTY OF DALLAS ss. On this 5th day of March • ••p\NG CO,b•e• • ; O?Qii P 0 9 : °9' • •?.. •• • cc ▪ 1933 By �.• •y j. • 6s4, •`1a,• • w • MERCHANTS BONDING COMPANY (MUTUAL) MERCHANTS NATIONAL BONDING, INC. President 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. /Owp. POLLY MASON Commission Number 750576 My Commission Expires January 07, 2023 Notary Public 4 (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 3rd day of February , 2021 ,• •'a(1 O Nq •' y O .seI% ri • ? ��tis of • 0 *'•. ••O, P O •co 12a. moo- IP OS Ze • w •Z 1933 3• . 2003 ..,p y'.. ti e °••gir• • * .;y fir '• es-vte-31‘. Secretary POA 0018 (1/20) FORM OF BID OR PROPOSAL FY 2021 SANITARY SEWER GA T FWELL REPAIRS PHASE I CONTRACT NO. 951 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 Iowa 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 AECOM 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 the FY 2021 SANITARY SEWER GATEWELL REPAIRS - PHASE I, CONTRACT NO. 951, all in accordance with the above -listed documents and for the unit prices for work in place for the following items and quantities: FY 2019 SANITARY GATEWELL REPAIRS CONTRACT NO. 951 Item unit did Total did ©escri tion Unit Est. C� No._ p Price Price a u '1O,000 General Items LS 1 $61-1O,vo*o $ G 1 Mobilization and 2 Gatewell 3C-1 LS 1 $ 110t o o $ I I O1 o03 �' 3 Gatewell 3C-3 LS 1 $ j;t,w�! $ 21i vw' 4 Gatewell 3C-4 LS 1 $ I bo, °et $ 160, W) 5 Gatewell 3C-5 LS 1 $ 1 Z64 aw 4' $ ileeicAir 6 Gatewell 5D-2 LS 1 $ 104 003 e $ 70,5 90 t 7 Gatewell 5D-3 LS 1 $ 9P, our`. $ A» 8 Gatewell 5F-1 LS 1 $ J 36, 0w `'" $ / 10, au, `'' 9 Gatewell 5F-2 LS 1 $ 2ZJ, Gilt $ 220,crogur a' 10 Gatewell 5F-3 LS 1 $ I Zoo ()out $ 1214, ob i ' ' 11 Gatewell 5F-4 LS 1 $ 94, Geo $ 94,04° y `3 12 Gatewell 5F-5 LS 1 $ 210, on $ 2so, oo, e l Investigating Valvewell 5F-6 LS 1 $ 5 000 $ Si 0w 13 412 14 Gatewell 5F-7 LS 1 $ ZI0,We $ 2'iO, V O0 tr. 15 Gatewell 3D-2 LS 1 $ Zit), ooe $ ins OW °1 16 Gatewell 3D-3 LS 1 $ 210 our'` $ 2 !o, oo° m 0 17 Gatewell 3D-4 LS 1 $ 210, oou $ 2 id, co) 18 Gatewell 3D-5 LS 1 $ )4o, 0=10 �y $ i 40, ova Its Qs- 1 $130,0o?1° $ 230.Ooo 19 Gatewell 3E-3 LS Gatewell 1-1 Bid) LS 1 $ 204 aoo 5: $ 2° o''' s 20 Investigating (Base 21 Gatewell 1-2 LS 1 $/Q, .1 $ 1 �, 03° 4) `=' LS 1 $ 2a, oo $ to, aoo Gatewell 3A-1 Bid) 22 Investigating (Base FORM OF BID AECOM #60549334 CONTRACT NO. 951 FB-1 of 4 FY 2021 SANITARY SEWER GATEWELL REPAIRS - PHASE Item Unit Bid Total Bid Descri ti©n Unit Est, sty. p No. Price Pace _ 23 Gatewell 3A-2 LS 1 $ co; oo3 $ (0, oc) t' 24 Investigating Gatewell 5A-1 Bid) LS 1 $ 0s t S 20+ ov �= (Base 7n, 25 Gatewell 5A-2 LS 1 $ 4°cs. *2 $ 4e t e 26 Gatewell 5A-3 LS 1 $ 4? D11- $ *ow -Pi to tj- 27 Gatewell 5A-4 LS 1 $ O43 $ io, ooa $3 935OOo°-° TOTAL BASE BID BID ALTERNATE 1 28 Gatewell 1-1 Alternate) LS 1 $ 14, MP $ 14a, v»o) (Bid t I4 TOTAL BID ALTERNATE 1 $ 03 BID ALTERNATE 2 29 Gatewell 3A-1 Alternate) LS 1 $ ar=.a $ 1 +, CX ? (Bid `-° TOTAL BID ALTERNATE 2 $ 1444 Au BID ALTERNATE 3 30 Gatewell 5A-1 Alternate) LS 1 $ 115 O $ 115' 00s t (Bid t TOTAL RID ALTFRNATE 3 11 S 0411 BID ALTERNATE 4 sat$ t 31 Valvewell 5F-6 Alternate) LS 1 $ 1 S, 040 15, 004 J (Bid • lc TOTAL BID ALTERNATE 4 $ vw 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 5% ($ ) in the form of Bid Bond , is submitted herewith in accordance with the INSTRUCTIONS TO BIDDERS. 5. Attached hereto is a Non -Collusion Affidavit of Prime Contractor. Dollars 6 Attached hereto is a Bidder Status Form indicating Resident Bidder Certification ( ), or Non -Resident Bidder Certification ( ). (Mark one.) 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 EGG, within ten (10) days of notification that the bid submitted is lowest and acceptable. 9. The bidder has received the following Addendum or Addenda: Addendum No. 1 Date February 8th, 2021 FORM OF BID CONTRACT NO. 951 AECOM #60549334 FB-2 of 4 FY 2021 SANITARY SEWER GATEWELL REPAIRS - PHASE 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. 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. BY: WRH Inc. February 11 th, 2021 (Name of Bidder) (Date) Bruce Marsh Official Address: (Including Zip Code): P.O Box 256 Amana, IA 52203 Title Vice President I . R. S No. 42-1012899 FORM OF BID CONTRACT NO. 951 AECOM #60549334 FB-3 of 4 FY 2021 SANITARY SEWER GATEWELL REPAIRS - PHASE I NON -COLLUSION AFFIDAVIT OF PRIME BIDDER State of Iowa )ss County of Iowa Bruce Marsh , being first duly sworn, deposes and says that: 1 He is (Owner, Partner, Officer, Representative, or Agent) , of WRH Inc. , the Bidder that has submitted the attached Bid; 2 He is fully informed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid; 3. Such Bid is genuine and is not a collusive or sham Bid; 4. Neither the said Bidder nor any of its officers, partners, owners, agents, representatives, employees, or parties in interest, including this affiant, has in any way colluded, conspired, connived or agreed, directly or indirectly, with any other Bidder, firm or person to submit a collusive or sham Bid in connection with the Contract for which the attached Bid has been submitted or to refrain from bidding in connection with such Contract, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or conference with any other Bidder, firm or person to fix the price or prices in the attached Bid or of any other Bidder, or, to fix any overhead, profit or cost element of the bid price or the bid price of any other Bidder, or to secure through any collusion, conspiracy, connivance, or unlawful agreement any advantage against the City of Waterloo, Iowa, or any person interested in the Proposed Contract; and 5 The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the Bidder or any of its agents, representatives, owners, employees, or parties in intere including this affiant. (Signed) 4 Vice President Subscribed and sworn to before me this 1 1 th \(\1(\\tAA, \AM\ trq My commission expires August 17th, 2023 NON -COLLUSION AFFIDAVIT CONTRACT NO. 951 AECOM #60549334 • Title day of February Title 2021 . Office Assistant ASHLEY MARIE MANNING Notarial Seal - Iowa Commission Number 826314 My Commission Expires Aug 17, 2023 NCA-1 of 2 FY 2021 SANITARY SEWER GATEWELL REPAIRS - PHASE I Maley Status Form To be completed by all bidders IF -sari: Please answer "Yes" or "No" for each of the following: I I I 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 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: 06 / 11 / 1995 to Curreq / Address: P.O Box 256 City, Zip:Amana IA, 52203 , State, Dates: / / to / / Address: City, State, Zip: Dates: / / to / / Address: You may attach additional sheet(s) if needed. City, State, Zip: F 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? 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. Yes I I No You may attach additional sheet(s) if needed. ed 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: WRH Inc. Signature:/tif Date: February 11 th, 2021 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) BSF-1 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. to Yes ■ No My business is currently registered as a contractor with the Iowa Division of Labor. Yes I 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 2 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. ❑ Yes E 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. Ell 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 limited partnership is filed in a state other than Iowa the limited partnership or limited liability limited partnership has received notification from the Iowa secretary of state that the application for certificate of authority has been approved and no notice of cancellation has been filed by the limited partnership or the limited liability limited partnership. My business is a limited liability company whose certificate of organization is filed in Iowa and has not filed a statement of termination. ■ Yes 2No Yes I 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) BSF-2 NESS ENTERPRISE MBE/WBE BUS PRE-B0J CONTACT INFORMATION FORM r 0 N4-1 r r U c a) 0 a_ Prime Contractor Name: a) 0 a) cn O 0 U a. 2 E O p U 0 0 4-1 11.2 0 0 (o O 0 co c (o • W" m — 0 c w O) _c c O a Z (0 a) 1 co.0 OI 0 4- CO • 0 t U LL z wn U c V ! O 0 7 r O N r arN (13 a) 1 0 Vice President Contractor Signature: �FJ N CT c Q 0 CCI 0 Q) O 0 F-- O E ID 0 0 L 0 D E ance Office 319-291-4429. 0 O D 0 V) considered 0 0 L 0 L.- O 22 W 0 (n Q) c CO m 0 0 information on this Form 0 ance Officer, E 0 O cU O � (o � E O cn U 5 13 O c (o 1--;3 O gift U U Co • Q) O a) O .Q L. Q � O c c a O N w 0 E 0 O 0 IJ 0 Q E (o O U Q. 0 U v/ C VJ W4-- (o 0 0 _> 461 L 0 (1) 4' CD co (o 92. 0 N E O 0 (o ui 0) Q) E O (o 4- 0 0 13 E O o VV) i P Q q) Q) C W 0 a c� O O 41 O co O_ co c Q) s determined that the MBE/WBE Business n the event 0 U) 0 0 z 0 cn z 0 0 Z 0 to .o � li Ka .® `V sZ o n ON/saA Z Z `sza 7 send to ® 0 0 ON/1 *u 0 0 0 O z z z z Les r N o CD N 121 0 r 0 n w 0 CD M Subi 0 ^a)^, 0) 0 0) CONTRACT NO E Page 2 Attachment I SRF Required Front=End Specifications (This form must be completed and signed by Prime Contractor and submitted with the bid.) U S. Environmental Protection Agency Certification of Non -Segregated Facilities STATE REVOLVING FUND (Applicable to contracts, subcontracts, and agreements with applicants who are themselves performing Federally assisted construction contracts, exceeding $10, 000 which are not exempt from the provisions of the Equal Opportunity clause.) By the submission of this bid, the bidder, offeror, applicant, or subcontractor certifies that he does not maintain or provide for his employees any segregated facilities at any of his establishments, and that he does not permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. He certifies further that he will not maintain or provide for his employees any segregated facilities at any of his establishments, and that he will not permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. The bidder, offeror, applicant, or subcontractor agrees that a breach of this certification is a violation of the Equal Opportunity clause in this contract. As used in this certification, the term "segregated facilities" means any waiting rooms, work areas, restrooms and washrooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, creed, color, or national original, because of habit, local custom, or otherwise. He further agrees that (except where he has obtained identical certifications from proposed subcontractors for specific time periods) he will obtain identical certifications from proposed subcontractors prior to the award of subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Opportunity clause; that he will retain such certifications in his files; and that he will forward the following notice to such proposed subcontractors (except where the proposed subcontractors have submitted identical certifications for specific time periods): NOTICE TO PROSPECTIVE SUBCONTRACTORS OF REQUIREMENT FOR CERTIFICATIONS OF NON -SEGREGATED FACILITIES A Certification of Non -segregated Facilities, as required by the May 9, 1967, order (33 F.R. 7808, May 28, 1968) on Elimination of Segregated Facilities, by the Secretary of Labor, must be submitted prior to the award of a subcontract exceeding $10,000 which is not exempt from the provisions of the Equal Opportunity clause. The certification may be submitted either for each subcontract or for all subcontracts during a period (i.e., quarterly, semiannually, or annually). February 11 th, 2021 Signature Date Bruce Marsh Vice Predident Name and Title of Signer (Please Type) NOTE. The penalty for making false statements in offers is prescribed in 18 U S.C. 1001. EPA-7 5720-4.2 INVESTING IN IOWA'S WATER vvti w.iowasrt.0 (l May 2015 Page 3 Attachment 2 SRF Required Front=End Specifications (This form must be completed and signed by the Prime Contractor anHI submitted with the bid.) Debarments and Suspensions STATE Any bidder or equipment supplier whose firm or affiliate is listed in on the U S GeneraFIESNITMD Administration Excluded Parties List System web site at http://www.epls.qov/ will be prohibited from the bidding process. Anyone submitting a bid who is listed on this web site will be determined to be a non -responsive bidder in accordance with 40 CFR Part 31. United States Environmental Protection Agency Washington, DC 20460 Certification Regarding Debarment, Suspension, and Other Responsibility Matters The prospective participant certifies to the best of its knowledge and belief that it and the principals: (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; (b) Have not within a three year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission o f fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction: violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (c) Are not presently indicted for otherwise criminally or civilly charged by a government entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification; and (d) Have not within a three-year period preceding this application/proposal had one or more public transaction s (Federal, State, or local) terminated or cause or default. I understand that a false statement on this certification may be ground for rejection of this proposal or termination of the award. In addition, under 18 U SC Sec. 10 01, a false statement ma y result in a fine of up to $10,000 or imprisonment for up to 5 years, or both. Bruce Marsh Vice Predident Typed Name & Title of Authorized Representative 4/14-A February 11 th, 2021 Signature of Authorized Representative Date ri I am unable to certify to the above statements. My explanation is attached. EPA Form 5700-49 (11-88) INVESTING IN IOWA'S WATER Vk/V VV,iowasr .corT) May 2015 Page 4 Attachment 3 SRF Required Frontal-1:nd Specifications (This form must be completed and signed by Prime Contractor and submitted with the bid.) STATE Disadvantaged Business Enterprise (DBF) Solicitation REVOLVING FUND It is EPA's policy that recipients of EPA financial assistance through the State Revolving Fund programs award a "fair share" of subagreements to small, minority and women -owned businesses, collectively know as Disadvantaged Business Enterprises (DBEs). Iowa's Fair Share goals are: Women Business Minority Business -Owned -Owned Enterprise Goal Enterprise Goal (WBE) (MBE) 2 2% Construction 1.7% Supplies 0.6% 5.6% Services 2 5% 11.3% 10.4% 2.5% Goods/Equipment Average 1.8% 7.4% Only work performed by certified DBEs can be counted toward the goals. In Iowa, DBEs must be certified through the Iowa Department of Transportation (IDOT). Information on certification requirements and a list of certified DBEs is on the IDOT website at http://www.iowadot.gov/contracts/contracts eeoaa.htm. Prime contractors' DBE requirements for SRF projects include: Taking affirmative steps for DBE participation • Documenting the efforts and the proposed utilization of certified DBEs PROJECT INFORMATION SRF Applicant: Bidder: WRH Inc. Address: P.O Box 256 Amana, IA 52203 Contact Person: Bruce Marsh Signature: Phone Number: 319-622-3816 E-Mail Address: bmarsh@wendlerinc.com Check if Prime Contractor is: Minority -Owned ❑Women -Owned INVESTING IN IOWA'S WATER \Ajwti°d.io` !asr .cone May 2015 Page 5 GOOD FAITH EFFORTS CHECKLIST P lease complete the checklist to determine if you have complied with the requirement good faith efforts to ensure that certified DBEs have the opportunity to compete for procurements funded by EPA financial assistance funds. Bidders/offerers must make efforts prior to submission of bids/proposals. 1. Did you ensure that DBEs are made aware of contracting opportunities to the fullesTE practicable through outreach and recruitment activities? E Yes ❑ No REVOLVING FUND 2. Did you make information on forthcoming opportunities available to DBEs and arrange time frames for contracts and establish delivery schedules, where the requirements permit, in a way that encourages and facilitates participation by DBEs in the competitive process? This includes, whenever possible, posting solicitation for bids or proposals for a minimum of 30 calendar days before the bid or proposal closing date. p Yes ■ No 3. Did you consider in the contracting process whether firms competing for large contracts could subcontract with DBEs? This will include dividing total requirements, when economically feasible, into smaller tasks or quantities to permit maximum participation by DBEs in the competitive process. ® Yes ■ No 4. Did you encourage contracting with a consortium of DBEs when a contract is too large for one of these firms to handle individually? Ki Yes ❑ No 5. Did you use the services of the Small Business Administration and the Minority Business Development Agency of the Department of Commerce to identify potential subcontractors? Yes ❑ No I 6. List the potential DBE subcontractors that were contacted. Only list those that are certified through the Iowa Department of Transportation. Name How (e.g. call, fax, Contacted letter, phone Response not Interested (e.g. did not not respond, competitive) e-mail) AG Constructions E-mail Did not respond Boone Construction E-mail Did not respond DND Inc E-mail Did not respond Electric, Iowa Landscape Supply E-mail Did not respond Midwest Contractors, Inc. E-mail Did not respond OEL Construction Did not respond E-mail P ROPOSED UTILIZATION OF DBE SUBCONTRACTORS P lease include Attachments 4 and 5 to document the proposed utilization of certified DBE subcontractors. INVESTING IN IOWA'S WATER Udi/vvviovvasrf.sofil May 2015 Page 6 CONTRACT ADMINISTRATION PROVISIONS Several contract provisions are required to prevent unfair practices that adversely affe These include: 1. Prime Contractor must pay its Subcontractor for satisfactory performance no mor days from the Prime Contractor's receipt of payment from the SRF loan recipient. STATE Prime Contractor must notify the SRF loan recipient in writing prior to termination cit' tOBEUNO subcontractor for convenience. 3. Prime Contractor must employ the six Good Faith Efforts to solicit a replacement subcontractor if a DBE subcontractor fails to complete work under a subcontract for any reason. INVESTING IN IOWA'S WATER vti�brdwd.ickviasr t.corn May 2015 Page 7 Attachment 4 SRF Required Front -End Specifications (This form must be completed and signed by Prime and DBE Su for each subcontract and submitted with the bid.) trol No: 2090-0030 proved 8/13/2013 I Expires 8/31/2015 United States Environmental Protection Agency Disadvantaged BusSeCErprise Program DBE SubconiTiWaGMlformance Form This form is intended to capture the DBE1 subcontractor's2 description of work to be performed and the price of the work submitted to the prime contractor. An EPA Financial Assistance Agreement recipient must require its prime contractor to have its DBE subcontractors complete this form and include all completed forms in the prime contractor's bid or proposal package Subcontractor Name Project FY 2021 Name Sewer Gatewell Repairs -Phase I Sanitary Bid/Proposal No. Assistance (if known) Agreement ID No. Point of Contact Address Telephone No. Email Address Prime WRH Contractor Inc. Name Issuing/Funding Entity Contract Number Item Description of Construction, Work Submitted Services, to the Equipment Prime Contractor or Supplies Involving Price of the Work Prime Submitted Contractor to DBE Certified Other by DOT SBA Meets/exceeds YES EPA certification NO standards? Unknown .A DBE is a Disadvantaged, Minority, or Woman Business Enterprise that has been certified by an entity from which EPA accepts certification as described in 40 CFR 33.204-33.205 or certified by EPA EPA accepts certifications from entities that meet or exceed EPA certification standards as described in 40 CFR 33.202 2Subcontractor is defined as a company, firm, joint venture, or individual who enters into an agreement with a contractor to provide services pursuant to an EPA award of financial assistance. EPA Form 6100-3 (DBE Subcontractor Performance Form) — Page 1 INVESTING IN IOWA'S WATER '.iowasr.0 ;rn May 2015 Page 8 No: 2090-0030 proved 8/13/2013 Expires 8/31/2015 United States Environmental Protection Agency Disadvantaged Bus prise Program DBE Subcont ' • rformance Form STATE I certify under penalty of perjury that the forgoing statements are true and correct. Signing thisfircYMItithtittMot signify a commitment to utilize the subcontractors above. I am aware of that in the event of a replacement of a subcontractor, I will adhere to the replacement requirements set forth in 40 CFR Part 33 Section 33.302 (c). Prime Contractor Signature Print Name Title Vice President Bruce Marsh February 11th, 2021 Date Subcontractor Signature Print Name Title Date The public reporting and recordkeeping burden for this collection of information is estimated to average three (3) hours per response. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division U S Environmental Protection Agency (2822T), 1200 Pennsylvania Ave , NW, Washington, D C. 20460. Include the OMB control number in any correspondence Do not send the completed form to this address. EPA Form 6100-3 (DBE Subcontractor Performance Form) — Page 2 INVESTING IN IOWA'S WATER wwvie.ioShiasr€,com May 2015 Page 9 Attachment 5 SRF Required Front -End Specifications (This form must be completed and signed by Prime Contractor and sub if utilizing DBE subcontractors.) e bid trol No: 2090-0030 proved 8/13/2013 Expires 8/31/2015 United States Environmental Protection Agency Disadvantaged BusSeTt Eerprise Program DBE SubdfM %WP'Qltilization Form This form is intended to capture the prime contractor's actual and/or intended use of identified certified DBE1 subcontractors2 and the estimated dollar amount of each subcontract. An EPA Financial Assistance Agreement Recipient must require its prime contractors to complete this form and include it in the bid or proposal package. Prime contractors should also maintain a copy of this form on file Project Name Prime Contractor Name WRH Inc. FY 2021 Sanitary Sewer Gatewell Repairs I -Phase Bid/Proposal No. Assistance (if known) Agreement ID No. Point of Contact Address P.O Box 256 Amana, IA 52203 Telephone No. Email Address 319-622-3816 bmarsh@wendlerinc.com Issuing/Funding Entity DBE I have identified potential certified subcontractors YES NO the table below. If no, explain: If yes, please complete please Estimated Dollar Currently DBE Subcontractor Company Address/Phone/Email Amount Certified? Name/Company Name Continue on back if needed 'A DBE is a Disadvantaged, Minority, or Woman Business Enterprise that has been certified by an entity from which EPA accepts certification as described in 40 CFR 33.204-33.205 or certified by EPA EPA accepts certifications from entities that meet or exceed EPA certification standards as described in 40 CFR 33.202. 2Subcontractor is defined as a company, firm, joint venture, or individual who enters into an agreement with a contractor to provide services pursuant to an EPA award of financial assistance. EPA Form 6100-4 (DBE Subcontractor Utilization Form) — Page 1 INVESTING IN IOWA'S WATER ,iowasi c.corn May 2015 Page 10 United States Environmental Protection Agency Disadvantaged Ru DRE Subc No: 2090-0030 roved 8/13/2013 xpires 8/31/2015 prise Program tilization Form I certify under penalty of perjury that the forgoing statements are true and correct. Signing this 4 rr iATot signify a commitment to utilize the subcontractors above. I am aware of that in the event of a replacemertiOnfliscsuintontractor, I will adhere to the replacement requirements set forth in 40 CFR Part 33 Section 33.302 (c). Prime Contractor Signature Print Name t‘ar Title Bruce Marsh Date Vice President February 11 th, 2021 The public reporting and recordkeeping burden for this collection of information is estimated to average three (3) hours per response. Send comments on the Agency's need for this information the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division U.S Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D C. 20460. Include the OMB control number in any correspondence Do not send the completed form to this address. EPA Form 6100-4 (DBE Subcontractor Utilization Form) — Page 2 INVESTING IN IOWA'S WATER wvieo .!owasrf.corn May 2015